Achieving Donor Management Goals Before Deceased Donor Procurement Is Associated With More Organs Transplanted Per Donor

Malinoski, Darren; Daly, Michael C.; Patel, Madhukar S.; Oley-Graybill, Chrystal; Foster, Clarence E.; Salim, Ali

doi:10.1097/ta.0b013e31822779e5

Cited by 64 publications

(63 citation statements)

References 19 publications

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“…This revised checklist was created on the basis of recommendations from the Canadian Council for Donation and Transplantation (12), previous regional DMG data (4), and the experiences and expert opinions of representatives from the eight OPOs in UNOS Region 5 (see the Acknowledgements section for the list of OPOs). Similar to as described in a previous report (5), the administration of thyroid hormone and measurement of serum creatinine were not considered as DMGs, but their impact on graft function was also analyzed.…”

Section: Donor Management Goalsmentioning

confidence: 99%

“…The DTCP encourages the utilization of preset critical care endpoints as donor management goals (DMG) in order to increase both the number of organs transplanted per donor (OTPD) as well as overall conversion rates. Meeting predefined DMGs has demonstrated beneficial effects on OTPD (2)(3)(4)(5). However, there are often reasons for organ acceptance/declination that are unrelated to donor management or graft quality, making it difficult to truly identify best practices by merely focusing on organ utilization/transplantation rates.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Impact of Meeting Donor Management Goals on the Development of Delayed Graft Function in Kidney Transplant Recipients

Malinoski¹,

Patel

Ahmed

et al. 2013

American Journal of Transplantation

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Many organ procurement organizations (OPOs) utilize preset critical care endpoints as donor management goals (DMGs) in order to standardize care and improve outcomes. The objective of this study was to determine the impact of meeting DMGs on delayed graft function (DGF) in renal transplant recipients. All eight OPOs of the United Network for Organ Sharing Region 5 prospectively implemented nine DMGs in every donor after neurologic determination of death (DNDD). "DMGs met" was defined a priori as achieving any seven of the nine DMGs and this was recorded at the time of consent for donation to reflect donor hospital ICU management, 12-18 h later, and prior to organ recovery. Multivariable analyses were performed to identify independent predictors of DGF (dialysis in the first week after transplantation) with a p < 0.05. A total of 722 transplanted kidneys from 492 DNDDs were included. A total of 28% developed DGF. DMGs were met at consent in 14%, 12-18 h in 32% and prior to recovery in 38%. DGF was less common when DMGs were met at consent (17% vs. 30%, p = 0.007). Independent predictors of DGF were age, Cr and cold ischemia time, while meeting DMGs at consent was significantly protective. The management of potential organ donors prior to consent affects outcomes and should remain a priority in the intensive care unit.

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Section: Donor Management Goalsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Impact of Meeting Donor Management Goals on the Development of Delayed Graft Function in Kidney Transplant Recipients

Malinoski¹,

Patel

Ahmed

et al. 2013

American Journal of Transplantation

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“…A growing concern for donor management has led to the development of donor management goals (DMGs, critical care end points aimed at restoring and stabilizing the physiological functions of deceased donors). 34 Like CTDN’s QIP to improve donor glucose control, these DMGs can be easily implemented given that all hospitals in a given donation service area are covered by one OPO. This arrangement makes it much easier and more feasible to educate OPO staff, implement a DMG and ensure adherence, given that it is a more centralized process.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Quality Improvement Project on Deceased Organ Donor Management

et al. 2015

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Context Donors showed poor glucose control in the period between declaration of brain death and organ recovery. The level of hyperglycemia in the donors was associated with a decline in terminal renal function. Objective To determine whether implementation of a quality improvement project improved glucose control and preserved renal function in deceased organ donors. Methods Data collected retrospectively included demographics, medical history, mechanism of death, laboratory values, and data from the United Network for Organ Sharing. Results After implementation of the quality improvement project, deceased donors had significantly lower mean glucose concentrations (mean [SD], 162 [44] vs 212 [42] mg/dL; P < .001) and prerecovery glucose concentration (143 [66] vs 241 [69] mg/dL; P < .001). When the donor cohorts from before and after the quality improvement project were analyzed together, mean glucose concentration remained a significant predictor of terminal creatinine level (P < .001). Multivariate analysis of delayed graft function in kidney recipients matched to donors indicated that higher terminal creatinine level was associated with delayed graft function in recipients (P < .001). Conclusion The quality improvement project improved donor glucose homeostasis, and the data confirm that poor glucose homeostasis is associated with worsening terminal renal function.

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“…1–4 Studies have shown that a higher compliance with DMGs and CBIGs results in a higher number of OTPD. 5–10 …”

Section: Introductionmentioning

confidence: 99%

Early declaration of death by neurologic criteria results in greater organ donor potential

Resnick

Seamon

Holena

et al. 2017

Journal of Surgical Research

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Background Aggressive management of patients prior to and after determination of death by neurologic criteria (DNC) is necessary to optimize organ recovery, transplantation, and increase the number of organs transplanted per donor (OTPD). The effects of time management are understudied but potentially pivotal component. The objective of this study was to analyze specific time points (time to DNC, time to procurement) and the time intervals between them to better characterize the optimal timeline of organ donation. Methods Using data over a 5-year time period (2011–2015) from the largest US OPO, all patients with catastrophic brain injury and donated transplantable organs were retrospectively reviewed. Active smokers were excluded. Maximum donor potential was seven organs (heart, lungs [2], kidneys [2], liver, and pancreas). Time from admission to declaration of DNC and donation was calculated. Mean time points stratified by specific organ procurement rates and overall OTPD were compared using unpaired t-test. Results Of 1719 Declaration of Death by Neurologic Criteria organ donors, 381 were secondary to head trauma. Smokers and organs recovered but not transplanted were excluded leaving 297 patients. Males comprised 78.8%, the mean age was 36.0 (±16.8) years, and 87.6% were treated at a trauma center. Higher donor potential (>4 OTPD) was associated with shorter average times from admission to brain death; 66.6 versus 82.2 hours, P = 0.04. Lung donors were also associated with shorter average times from admission to brain death; 61.6 versus 83.6 hours, P = 0.004. The time interval from DNC to donation varied minimally among groups and did not affect donation rates. Conclusions A shorter time interval between admission and declaration of DNC was associated with increased OTPD, especially lungs. Further research to identify what role timing plays in the management of the potential organ donor and how that relates to donor management goals is needed.

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Achieving Donor Management Goals Before Deceased Donor Procurement Is Associated With More Organs Transplanted Per Donor

Abstract: Meeting DMGs before procurement resulted in more OTPD. Donor factors and critical care end points are independent predictors of organ yield. Prospective studies are needed to determine the true impact of each DMG on the number and function of transplanted organs.

Cited by 64 publications

References 19 publications

The Impact of Meeting Donor Management Goals on the Development of Delayed Graft Function in Kidney Transplant Recipients

The Impact of Meeting Donor Management Goals on the Development of Delayed Graft Function in Kidney Transplant Recipients

Impact of a Quality Improvement Project on Deceased Organ Donor Management

Early declaration of death by neurologic criteria results in greater organ donor potential

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