Maximizing donors’ gifts: A comparison of actual and expected solid organ yield among VCA donors

Abstract

Vascularized Composite Allograft (VCA) transplantation provides life‐changing transplants, but VCA adds complexity to the donation process and timing, possibly impeding solid organ donation. Expanding upon descriptive analyses, this study examines risk‐adjusted predictions versus the observed number of organs donated by VCA donors. Our cohort included VCA donors in the United States during January 1, 2008–December 31, 2017 (n = 51), using OPTN Deceased Donor Registration Form data and the Scientific Registry of Transplant Recipients (SRTR) donor yield models to calculate observed‐to‐expected (O:E) yield ratios. Almost all VCA donors’ livers (48/51; 94.1%) and kidneys (92/102; 90.2%) were transplanted, with fewer hearts (28/51; 54.9%), lungs (46/102; 45.1%), pancreata (15/51; 29.4%), and intestines (3/51; 5.9%) transplanted. O:E ratios for overall organ yield were slightly greater than expected for VCA donors (1.10; 95% CI: 1.02–1.17). Liver (1.17: 1.08–1.27) and lung yields (1.38: 1.07–1.68) were both greater than expected, while kidney, heart, and pancreas yields were similar to expected. Across VCA types, bilateral upper limb and abdominal wall donors had better‐than‐expected yields while uterus, face, and unilateral upper limb donors all had similar‐to‐expected yields. Solid organ yield among VCA donors was as good or better than predicted, suggesting that VCA donation does not compromise recovery and transplantation of lifesaving organs.

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

“…In order to evaluate the impact of DCD heart procurement on organ yield, an observed to expected ratio or "O:E ratio" was computed using the models provided by the Scientific Registry of Transplant Recipients (SRTR) for OPO performance evaluation to calculated the expected yield of donor organs. 12 The analysis determines whether the observed organ yields of DCD heart procurements with intent to transplant (the MPH group) were statistically different from the expected yields for each organ and overall. The analysis divides the observed yield by the expected yield, where a ratio value of 1 would imply that the expected yield and observed yield are equal.…”

Vascularized Composite Allograft Transplantation in the United States: Current State of the Field and Future Challenges

“…This work will include the process of evaluating potential candidates and renewing and strengthening relationships with local organ procurement organizations. 2,8,9…”

“…This work will include the process of evaluating potential candidates and renewing and strengthening relationships with local organ procurement organizations. 2,8,9 A more chronic challenge to the field that needs to be resolved is funding. Out of 62 VCA transplant recipients in the United States since July 2014, 21 received free care (ie, the transplant hospital will not charge recipient for the costs of the transplant operation), and 15 were funded by donations, 7 by Medicare or Medicaid, 1 by the Department of Veterans Affairs, and 3 by private insurance.…”

Public Perceptions and Information Needs of VCA Transplantation and Donation: A Mixed Methods Study

“…There have been more than 100 VCAs performed in the United States since 1998, and over 165 VCAs have been performed worldwide ( 4 , 5 ). Despite advances in the field, VCA authorization and subsequent donation rates in the US remain low, and information needs of the public regarding VCA transplantation and donation are little examined, which may help explain low prevalence of VCA ( 6 ).…”