Characterizing proximity and transfers of deceased organ donors to donor care units in the United States

Vail, Emily A.; Tam, Vicky W.; Sonnenberg, Elizabeth M.; Lavu, Nikhil R.; Reese, Peter P.; Abt, Peter L.; Martin, Niels D.; Hasz, Richard D.; Olthoff, Kim M.; Kerlin, Meeta P.; Christie, Jason D.; Neuman, Mark D.; Potluri, Vishnu S.

doi:10.1016/j.ajt.2024.02.007

Cited by 2 publications

(3 citation statements)

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“…First, observational studies of DCU processes and outcomes are inherently limited by donor selection bias; even when DCUs are available, not all deceased donors are transferred. As in past studies, individual DCUs varied in the proportion of donors transferred from area hospitals. This may reflect systematic or individual differences in available local hospital or transportation resources or donor characteristics (including clinical stability and family authorization for transfer) between areas.…”

Section: Discussionmentioning

confidence: 75%

“…In a US system characterized by heterogeneity of practices, resources, and outcomes among diverse hospitals, OPOs, and transplant programs, the impact of DCUs on individual stakeholders is also likely to vary. Furthermore, results may not be generalizable to newly opened DCUs and, given that donor management is rarely shared or transferred between organ procurement organizations, do not apply to the majority of US donor service areas without operating DCUs . As the study dataset lacks relevant information about the clinical conditions and management of deceased donors, we could not compare quality or intensity of donor management between groups .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, results may not be generalizable to newly opened DCUs and, given that donor management is rarely shared or transferred between organ procurement organizations, do not apply to the majority of US donor service areas without operating DCUs. 3 , 30 As the study dataset lacks relevant information about the clinical conditions and management of deceased donors, we could not compare quality or intensity of donor management between groups. 5 , 6 , 43 Similarly, we could not account for recipient care delivery variables (eg, ventilator settings) associated with short- and long-term outcomes but not captured in the study dataset.…”

Section: Discussionmentioning

confidence: 99%

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Lung Donation and Transplant Recipient Outcomes at Independent vs Hospital-Based Donor Care Units

Vail,

Wang,

Schaubel

et al. 2024

JAMA Netw Open

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ImportanceCentralizing deceased organ donor management and organ recovery into donor care units (DCUs) may mitigate the critical organ shortage by positively impacting donation and recipient outcomes.ObjectiveTo compare donation and lung transplant outcomes between 2 common DCU models: independent (outside of acute-care hospitals) and hospital-based.Design, Setting, and ParticipantsThis is a retrospective cohort study of Organ Procurement and Transplantation Network deceased donor registry and lung transplant recipient files from 21 US donor service areas with an operating DCU. Characteristics and lung donation rates among deceased donors cared for in independent vs hospital-based DCUs were compared. Eligible participants included deceased organ donors (aged 16 years and older) after brain death, who underwent organ recovery procedures between April 26, 2017, and June 30, 2022, and patients who received lung transplants from those donors. Data analysis was conducted from May 2023 to March 2024.ExposureOrgan recovery in an independent DCU (vs hospital-based DCU).Main Outcome and MeasuresThe primary outcome was duration of transplanted lung survival (through December 31, 2023) among recipients of lung(s) transplanted from cohort donors. A Cox proportional hazards model stratified by transplant year and program, adjusting for donor and recipient characteristics was used to compare graft survival.ResultsOf 10 856 donors in the starting sample (mean [SD] age, 42.8 [15.2] years; 6625 male [61.0%] and 4231 female [39.0%]), 5149 (primary comparison group) underwent recovery procedures in DCUs including 1466 (28.4%) in 11 hospital-based DCUs and 3683 (71.5%) in 10 independent DCUs. Unadjusted lung donation rates were higher in DCUs than local hospitals, but lower in hospital-based vs independent DCUs (418 donors [28.5%] vs 1233 donors [33.5%]; P &lt; .001). Among 1657 transplant recipients, 1250 (74.5%) received lung(s) from independent DCUs. Median (range) duration of follow-up after transplant was 734 (0-2292) days. Grafts recovered from independent DCUs had shorter restricted mean (SE) survival times than grafts from hospital-based DCUs (1548 [27] days vs 1665 [50] days; P = .04). After adjustment, graft failure remained higher among lungs recovered from independent DCUs than hospital-based DCUs (hazard ratio, 1.85; 95% CI, 1.28-2.65).Conclusions and RelevanceIn this retrospective analysis of national donor and transplant recipient data, although lung donation rates were higher from deceased organ donors after brain death cared for in independent DCUs, lungs recovered from donors in hospital-based DCUs survived longer. These findings suggest that further work is necessary to understand which factors (eg, donor transfer, management, or lung evaluation and acceptance practices) differ between DCU models and may contribute to these differences.

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Section: Discussionmentioning

confidence: 75%