The 20-year paradigm shift toward organ recovery centers: 2500 donors at Mid-America Transplant and broader adoption across the United States

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

“…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.…”

“…Organ donors were classified using recovery procedure location and name variables in the study dataset as previously described, 9 then categorized according to published literature. 3 Recipients of lungs from cohort donors were also compared according to the site of lung recovery.…”

“…Nearly one-half of OPOs operate a DCU in 1 of 2 commonly used models: (1) hospital-based, sharing some or all resources (including staff and beds) with hospitalized patients (under contract with the hospital), and (2) independent, which resemble intensive care units and operating rooms but lack hospital affiliations or licensed beds. 3 …”

“…Nearly one-half of OPOs operate a DCU in 1 of 2 commonly used models: (1) hospital-based, sharing some or all resources (including staff and beds) with hospitalized patients (under contract with the hospital), and (2) independent, which resemble intensive care units and operating rooms but lack hospital affiliations or licensed beds. 3 While individual OPOs operate DCUs according to available local hospital resources, operational needs, and finances, each DCU model offers unique advantages, which include lower donor management costs among donors in independent DCUs, 4 and access to consultant physicians or additional clinical resources (eg, cardiac catheterization laboratories) in hospital-based DCUs. 3 Differences between models may be particularly impactful for lung donation because some acute complications of brain death (eg, atelectasis) are mitigated with lung donor-specific protocols 5 or interventions (eg, lung-protective ventilation 6 or prone positioning 7 ), which may be delivered more consistently in independent DCUs than hospitals.…”

Deceased Organ Donor Management and Organ Distribution From Organ Procurement Organization-Based Recovery Facilities Versus Acute-Care Hospitals

“…tissue biopsies) may be performed by OPOs attempting to allocate higher-risk organs or at the request of transplant programs assessing offered organs and cannot be attributed to decision-making or practices unique to facilities alone. Study data were insufficient to examine whether other reported benefits of a single OPO-based facility (including satisfaction of donor families and recovering surgeons, and satisfaction and retention of OPO staff) 27 apply to other operating facilities or to examine other factors (such as clinical staffing resources and staff workload) likely to differ between facilities and hospitals.…”