Donor management using a specialized donor care facility is associated with higher organ utilization from drug overdose donors

Abstract

Drug overdoses have tripled in the United States over the last two decades. With the increasing demand for donor organs, one potential consequence of the opioid epidemic may be an increase in suitable donor organs. Unfortunately, organs from donors dying of drug overdose have poorer utilization rates than other groups of brain‐dead donors, largely due to physician and recipient concerns about viral disease transmission. During the study period of 2011 to 2016, drug overdose donors (DODs) account for an increasingly greater proportion of the national donor pool. We show that a novel model of donor care, known as specialized donor care facility (SDCF), is associated with an increase in organ utilization from DODs compared to the conventional model of hospital‐based donor care. This is likely related to the close relationship of the SDCF with the transplant centers, leading to improved communication and highly efficient donor care.

Organ Transplantation Outcomes of Deceased Organ Donors in Organ Procurement Organization-Based Recovery Facilities Versus Acute-Care Hospitals

“… 5 A separate study using data from 661 donors managed in the same facility found higher numbers of organs donated from donors that died after drug overdose than national averages, but no differences among donors with other causes of death. 8 This work confirms and extends these prior studies by using a national donor sample, examining outcomes in multiple facilities, and adjusting outcomes for individual donor characteristics and managing OPOs. Adjustment for individual OPO is particularly important given known regional differences in donor characteristics and acute healthcare resources, as well as variation in donor identification, management, and performance among US OPOs.…”

“…Single-facility evaluations have suggested improved organ donation outcomes and several practical advantages over hospital-based recovery, 4 ‐ 8 but results may not be generalizable to donors in other regions, managing OPOs, or facilities. Furthermore, understanding nationwide effectiveness of OPO-based recovery facilities is complicated by variation in the rates of facility use among OPOs (not all donors in a donor service area are transferred to an OPO-based facility) and known regional differences in donor characteristics and OPO performance.…”

“…Facility-based donor management and organ recovery may differ from acute-care hospitals in many aspects, including clinical tasks performed by OPO staff (such as bronchoscopy and tissue biopsy), and availability of advanced diagnostic and treatment modalities (such as coronary catheterization). 4,5 Single-facility evaluations have suggested improved organ donation outcomes and several practical advantages over hospitalbased recovery, [4][5][6][7][8] but results may not be generalizable to donors in other regions, managing OPOs, or facilities. Furthermore, understanding nationwide effectiveness of OPO-based recovery facilities is complicated by variation in the rates of facility use among OPOs (not all donors in a donor service area are transferred to an OPO-based facility) and known regional differences in donor characteristics and OPO performance.…”

Beyond donation to organ utilization in the USA

“…After stagnating in the late 2000s, the annual number of deceased donors in the USA began a remarkable and sustained climb, increasing 83% between 2012 (8143 donors) and 2022 (14 903) [2], a rise at least partially associated with the drug overdose epidemic [3]. And as OPO performance has been increasingly scrutinized [4][5][6][7], the donor pool has not only increased but has further broadened with respect to general acceptability criteria for candidacy: in 2022, over 31% of donors were aged 50-64 years, compared with 27% consistently each year from 2012 to 2018 [2].…”

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

“…4 Rapid facility opening 4,5 and model endorsement by a recent National Academies of Science, Engineering, and Medicine report 6 were based on early studies describing operational advantages and improved short-term donation outcomes (as measured by the number of organs transplanted per donor) from a single established OPO-based recovery facility. [7][8][9] However, those studies could not ascertain whether local benefits of OPO-facility use could be extrapolated to other regions and OPOs. To address the question of generalizability, a recent retrospective cohort study of 5010 adult deceased organ donors after brain death managed in 10 U.S. OPO regions demonstrated that donors transferred to OPO-based organ recovery facilities donated more transplanted organs on average than donors who remained in local acute-care hospitals.…”