Outcomes of a High-Volume Organ Procurement Organization in the Era of Increasing Donation After Circulatory Death

Abstract

Introduction: Donation after circulatory death (DCD) is rapidly increasing in the United States. Detailed data outlining the process from referral to organ transplantation is lacking. Project Aims: We sought to quantify differences at each stage along the referral to donation pathway by donor type. Additionally, we examined factors associated with successful DCD organ utilization. Design: This program evaluation analyzed data from a single organ procurement organization in 2018 to assess demographic and clinical predictors of progression through the donation process, including the role of first-person authorization in DCD. Descriptive statistics were examined by donation stage for demographic characteristics using chi-square; univariate and multivariate logistic regression was used to model predictors of utilization and authorization by organ type, respectively. Results: There were 2466 organ donation referrals during 2018, including 575 donations after brainstem death (DBD), 1890 controlled DCD referrals, and 1 uncontrolled DCD referral. Univariate and multivariate logistic regression models highlighted differences in authorization rates by donor type (DCD vs DBD) and by age, race, and ethnicity. Next-of-kin authorization was declined in 23% of first-person authorized potential DCD, highlighting issues related to the role of donor registration in DCD. Pre-mortem heparin administration was predictive of DCD organ utilization; donor age and warm ischemia time of less than 30 min was statistically significantly associated with DCD extra-renal organ utilization. Conclusion: These results provided insight into strategies for increasing authorization and transplantation of organs from DCD donors and identified areas of improvement for process standardization and policy development.

Beyond donation to organ utilization in the USA

“…Growth in DCD donation owes to the evolving composition of the deceased donor pool; concerted efforts by OPOs to improve DCD identification, family authorization and recovery processes [52]; technological innovations; increased centre-level willingness to accept DCD offers; and a cross-institutional feedback loop (increased centre acceptance ! increased OPO recovery) [53].…”

“…Growth in DCD donation owes to the evolving composition of the deceased donor pool; concerted efforts by OPOs to improve DCD identification, family authorization and recovery processes [52]; technological innovations; increased centre-level willingness to accept DCD offers; and a cross-institutional feedback loop (increased centre acceptance → increased OPO recovery) [53]. International comparisons [8,54,55] and marked geographic heterogeneity in DCD utilization [56,57] all suggest DCD donation represents a prominent area for further growth in the USA.…”

A Rapid Scoping Review of the Dual Advocacy Model for Donation Conversations

“…1,2 While several factors are responsible, one is the failure of the public to predesignate themselves as donors, either through online state registries or motor vehicle departments. Donation rates can exceed 90% when deceased donors are registered 1 but fall to 33.5–68.6% when not predesignated, 1,3 with minority populations having lower rates of authorization compared to whites. 4 Another missing factor is the standardization of effective processes of communicating with family decision-makers about the option to donate a dying or deceased patient's organs for transplantation.…”