Active Donor Management During the Hospital Phase of Care Is Associated with More Organs Transplanted per Donor

Patel, Madhukar S.; Cruz, Salvador De La; Sally, Mitchell B.; Groat, Tahnee; Malinoski, Darren

doi:10.1016/j.jamcollsurg.2017.06.014

Cited by 44 publications

(30 citation statements)

References 10 publications

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“…We also recognize that one potential future investigation would be to examine the Bundle over time and how it affects pancreatic acceptance and transplantation. As seen in a previous study, 28 model. In addition, future studies will address the length of time donor management occurs, which has not been carefully studied in pancreatic grafts.…”

Section: Pancreas Transplanted Pancreas Not Transplantedsupporting

confidence: 59%

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Deceased organ donor factors influencing pancreatic graft transplantation and survival

Sally

Ellis

Hutchens

et al. 2019

Clinical Transplantation

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Criteria for organ acceptance in brain-dead organ donors remain inconsistent, especially when concerning pancreatic transplants. We sought to examine donor-specific predictors of pancreatic graft use and survival to better guide the selection and management of potential donors. A prospective observational study of all donors from ten organ procurement organizations was conducted from March 2012 to January 2015. Critical care endpoints were collected at 4 standardized time points. Data associated with pancreatic transplantation and graft survival rates were first determined using univariate analyses, and then logistic regression was used to identify independent predictors of these two outcomes. From 1819 donors, 238 (13.1%) pancreata were transplanted, and at a mean follow-up of 192 days, 218 (91.6%) grafts had survived. After regression analysis, donor age (OR = 0.89), HgbA1C (OR = 0.07), and achieving the donor management goal (DMG) for ejection fraction at allocation of ≥50% (OR = 3.29) remained as independent predictors of pancreatic utilization.On regression analysis, graft survival was independently predicted by lower donor age (OR = 0.93) and achieving the DMGs for mean arterial pressure (60-110 mm Hg) and glucose (≤180 mg/dL) at separate time points. These results may help guide the management and selection of potential pancreatic donors after brain death. K E Y W O R D Scritical care, donation after brain death, insulin, organ acceptance, organ procurement

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Section: Pancreas Transplanted Pancreas Not Transplantedsupporting

confidence: 59%

“…As seen in a previous study, 28 positive Bundle status change does result in more OTPD; however, this metric has not been applied yet to individual organs. Many groups have addressed recipient factors and how they affect pancreatic graft function; however, these are not included in our current study.…”

Section: Discussionmentioning

confidence: 92%

Deceased organ donor factors influencing pancreatic graft transplantation and survival

Sally

Ellis

Hutchens

et al. 2019

Clinical Transplantation

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“…Cause of death, which may also influence this metric, has not changed over the study period (unpublished data). It was encouraging to note the high number of DMGs met at the time of authorization for donation, one of the factors known to improve organ yield . While many variables may impact whether DMG's are met, the implementation of the MAS‐formulated management protocol during the critical pre‐authorization phase may have contributed to this result.…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, it has previously been demonstrated that meeting donor management goals (DMGs) prior to consent for donation was independently associated with ≥four organs transplanted per donor (OTPD) . A more recent study also showed that meeting seven of nine DMGs during the donor hospital phase, which represents the management of the potential donor from the time of referral to the time of authorization for donation, resulted in >four OTPD . Intensive donor management continues until the time of organ retrieval, which usually occurs 9‐10 hours after authorization.…”

Section: Methodsmentioning

confidence: 99%

The implementation and utilization of an organ donation dedicated medical advisory service: A descriptive study

Cohen¹,

Ashkenazi²

2019

Clinical Transplantation

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Organ donation is a complex process involving several critical steps, from donor detection, the declaration of brain death, the family approach, and donor maintenance until organ recovery. Each of these steps may result in the loss of urgently needed organs for transplantation if not optimally managed.In 1997, the National Transplant Center in Israel established a network of full-and part-time in-hospital donor coordinators (DCs) who are active in all 21 donor hospitals, including five transplant centers, and who are responsible for managing and coordinating the donation process. As their central role became more established, they were increasingly consulted regarding issues or dilemmas arising during the process. These included queries related to safety, that is, the risk of donor-recipient transmission of serious disease through organ transplantation, and quality, that is, optimal management of a potential donor's physiological state. Despite receiving intensive and ongoing training, it became evident that there remained situations for which the DCs were unable to provide immediate and authoritative answers.In consideration of this, a decision was made by the National Center for Transplantation to establish a medical advisory service (MAS) dedicated to providing an online telephone consultation service for queries regarding all aspects of the donation process. This paper will describe the formation and implementation of the MAS. Abstract Background: Obstacles encountered during the organ donation process may result in the loss of organs. A centralized medical advisory service (MAS), providing a 24/7/365 service, was established in 2007 to respond to queries from healthcare professionals regarding organ safety, brain death (BD) determination, and donor management. Methods: Data collected from 2007 to 2017 included the number and context of the queries and the mean number of organs transplanted/donor. Since 2012, the number of six donor management goals (DMGs) met at the time of consent has been monitored. Results: The number of queries relative to the number of potential donors increased from 12.4% (n = 78 queries) in 2007 to 48.2% (304 queries) in 2009 and has remained widely utilized, with most queries consistently related to organ safety. The context of the queries informed the formulation of protocols relating to donor infections and malignancy and identified difficulties regarding BD determination and subsequent implementation of solutions. A mean of 5.0 ± 0.7 DMGs was achieved, while the number of organs transplanted/donor increased from 3.4 in 2007 to 4.0 in 2017. Conclusion:We suggest that this model may provide a valuable resource to improve the safety, standardization, and quality of the donation process. K E Y W O R D Sadvisory service, donor management, organ donation

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“…Advances in transplant surgical techniques and immunosuppressive therapies have led to increasing numbers of patients with end-stage organ failure being treated with an organ transplant. There is increasing evidence that success rates of transplantation can be improved with optimal management of the potential organ donor [1]. Thus it is important, after diagnosis of brain death, that optimal physiological support is maintained to allow the option of organ donation if this was the patient's known wish.…”

Section: Introductionmentioning

confidence: 99%

Intensive Care Society of Ireland — Guidelines for management of the potential organ donor (2018—2nd edition)

et al. 2019

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Active Donor Management During the Hospital Phase of Care Is Associated with More Organs Transplanted per Donor

Cited by 44 publications

References 10 publications

Deceased organ donor factors influencing pancreatic graft transplantation and survival

Deceased organ donor factors influencing pancreatic graft transplantation and survival

The implementation and utilization of an organ donation dedicated medical advisory service: A descriptive study

Intensive Care Society of Ireland — Guidelines for management of the potential organ donor (2018—2nd edition)

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