Disparities in DCD organ procurement policy from a national OPO survey: A call for standardization

Abstract

Introduction: Procurement practices across organ procurement organizations (OPOs) for donation after cardiac death (DCD) transplants have not been evaluated. Methods:A national telephone survey of all 58 OPOs inquiring about their procurement practices of DCD organs was conducted. Policies concerning maximum donor body mass index (BMI), location of care withdrawal, pre-mortem heparin administration, vasodilator use, wait times after declaration of death before incisions, inclinations between rapid laparotomy and pre-mortem cannulation, and maximum time before aborting DCD procurement were queried. Results:The survey revealed substantial differences across OPOs. Donor BMI restriction was considered by 36 of 58 OPOs, and 23 sites preferred OR for donor withdrawal of care. Pre-mortem heparin was utilized by 53 OPOs. Only 2 recommended vasodilators. Minimum wait time of 5-minutes was implemented by 41 OPOs. Rapid laparotomy was preferred by 57 organizations. 28 OPOs had a 90-minute limit before aborting DCD procurement. Conclusion:There are substantial variations across OPO protocols for procuring DCD organs. Current practices do not conform to ASTS guidelines for DCD procurement. Further investigations are needed to quantify the impact of OPO policies on transplant outcomes. K E Y W O R D Sasystolic waiting time, pre-mortem cannulation, rapid laparotomy, vasodilators, warm ischemic time

The impact of machine perfusion of the heart on warm ischemia time and organ yield in donation after circulatory death

“…Procurements were additionally excluded if no aortic cross-clamp time was recorded, or if any calculated WITs were less than or equal to 0 min or greater than 90 min (28 procurements). We chose 90 min as a maximum WIT given that it is the most common upper limit of WIT used by OPOs for acceptance of any DCD organ 11 ; if times were recorded as greater than 90 min, we believed these were errors in data entry and thus excluded.…”

Potential donor characteristics and decisions made by organ procurement organization staff: Results of a discrete choice experiment

“…Among other responsibilities, OPOs are required to evaluate all referrals of potential deceased organ donors from hospitals within their donation service area 1 . Under current policy and practice, each OPO defines its own clinical criteria for medical suitability of referrals for organ donation potential 2,3 . These clinical criteria vary among OPOs and are not visible to the transplant system.…”

“…1 Under current policy and practice, each OPO defines its own clinical criteria for medical suitability of referrals for organ donation potential. 2,3 These clinical criteria vary among OPOs and are not visible to the transplant system. OPO-level clinical criteria have historically ABBREVIATIONS: AOPO, Association of Organ Procurement Organizations; DCE, discrete choice experiment; HOPE Act, HIV Organ Policy Equity Act included HIV status.…”

Comments on “Regulations and Procurement Surgery in DCD Liver Transplantation: Expert Consensus Guidance From the International Liver Transplantation Society”

“…Our research group recently emphasized the variations in DCD organ procurement policies in the United States with a national organ procurement organization (OPO) survey. 2 We discovered tremendous disparities across regions that frequently diverged from American Society for Transplant Surgeons (ASTS) recommendations for DCD procurement and the latest consensus in the literature. It is paramount to optimize graft utilization and outcomes to meet the high demand for transplantable organs and growing waitlist.…”

“…Despite strong surgeon preference for both of these, our survey revealed that 26 OPO did not have specific regulations on the location of withdrawal of life support treatment and 3 OPO prohibited heparin use. 2,3 We hope that the ILTS recommendations lead to updates in DCD procurement protocol and regulations to comply with the latest evidence in the literature. We hope to see more analyses of liver perfusion solutions and the various additives.…”