Optimization of Donor Management Goals Yields Increased Organ Use

Abstract

Multiple strategies have been used in an effort to increase the pool of organs for transplantation. Standardizing donor management has produced promising results. Donor management goals (DMGs) are now being used as end points of intensive care unit care during the prerecovery phase but no prospective results have been reported. Data from the United Network for Organ Sharing Region 11 were collected for successful achievement of eight common donor management goals (mean airway pressure [MAP], central venous pressure [CVP], pH, PaO2, sodium, glucose, single pressor use, and urine output) before organ recovery. Two time periods were studied with different panels of DMGs. The analysis identified the success rate of transplantation. Goals were stratified by their statistical correlation with the number of organs transplanted per donor (OTPD) in an effort to identify the most important parameter(s). Eight hundred five organ donors were studied with 2685 organs transplanted. DMGs were assessed through two phases of the study. Achieving DMGs rose from 18 to 66 per cent associated with significant improvement in OTPD (range, 2.96 to 3.45). The success of transplantation was primarily associated with limitations in vasopressor use and PaO2. Tight glucose control did affect the rate of pancreatic transplants. Thoracic organs were the most sensitive to DMGs with a 10- to 15-fold increase in lung transplantation when PaO2 rose above 100 mmHg. MAP, CVP, pH, sodium, and urine output had little effect on transplantation. Standardization of end points of donor management was associated with increased rates of transplantation. Surprisingly, not all standard goals are necessary for optimal organ use. The most significant parameters were the low use of vasopressor agents and oxygenation. Donor management strategies should strive to optimize these goals.

The Impact of Meeting Donor Management Goals on the Number of Organs Transplanted per Expanded Criteria Donor

“…However, these studies 4,5 were limited to SCDs. In addition, a retrospective review of the UNOS Region 11 by Franklin et al 10 included ECDs in its study population but did not conduct a subgroup analysis of this population. In a separate study presenting the efforts of UNOS Region 10, Hagan et al 11 evaluated the effect of attaining specific DMGs on the number of organs transplanted per donor in all donors and also included a subgroup analysis of ECDs.…”

Management of the heartbeating brain-dead organ donor

“…49 Achievement of donor goals, low vasopressor use, and good glycaemic control are all associated with increased numbers of retrieved grafts. 59 Other organs…”

Care pathways for organ donation after brain death: guidance from available literature?

“…There has been a shift in the management strategies for the DBD from primarily correcting pathophysiological disturbances associated with brain death, to an algorithmic approach based on achieving clinically relevant end goals to increase the number and quality of transplantable organs (Franklin et al . , Dare et al . , Malinoski et al .…”