Organ procurement center allows for daytime liver transplantation with less resource utilization: May address burnout, pipeline, and safety for field of transplantation

Abstract

Abdominal organ transplantation faces several challenges: burnout, limited pipeline of future surgeons, changes in liver allocation potentially impacting organ procurement travel, and travel safety. The organ procurement center (OPC) model may be one way to mitigate these issues. Liver transplants from 2009 to 2016 were reviewed.There were 755 liver transplants performed with 525 OPC and 230 in-hospital procurements. The majority of transplants (87.4%) were started during daytime hours (5 am-7 pm). Transplants with any portion occurring after-hours were more likely to have procurements in-hospital (P < .001). Daytime cases (n = 400) had more OPC procured livers and hepatitis C recipients and were less likely to have a donation after circulatory death donor (all P < .05). In adjusted analyses, daytime cases were independently associated with extubation in the operating room and less postoperative transfusion. There were no significant differences in short-or long-term postoperative outcomes. For exported livers, 54.3% were procured by a local team, saving 137 flights (151 559 miles). The OPC resulted in optimally timed liver transplants and decreased resource utilization with no negative impact on patient outcomes. It allows for ease in exporting organs procured by local surgeons, and potentially addresses provider burnout, the transplant surgery pipeline, and surgeon travel. K E Y W O R D Sclinical research/practice, donors and donation: donor evaluation, editorial/personal viewpoint, education, liver transplantation/hepatology, organ procurement, organ procurement and allocation, organ procurement organization, organ transplantation in general | 1297 LINDEMANN Et AL. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Lindemann J, Dageforde LA, Brockmeier D, et al. Organ procurement center allows for daytime liver transplantation with less resource utilization: May address burnout, pipeline, and safety for field of transplantation.

Extinguishing burnout: National analysis of predictors and effects of burnout in abdominal transplant surgery fellows

“…One proposed reason may be financial hardship associated with child care on a fellow salary. Jesse et al found that difficulties with flexible childcare lead to higher rates of EE among transplant attendings 27 . The demands of a transplant fellowship may magnify these difficulties, often leaving a spouse to function as a single parent.…”

Chest computed tomography imaging improves potential lung donor assessment

“…Thus, chest CT may be a method of detecting poor quality or inappropriately sized lungs remotely, prior to sending a retrieval team to evaluate the organ. There is a substantial cost and risk to personnel associated with flying a retrieval team to evaluate organs [22], and improved methods of evaluating potential donors remotely are greatly needed.…”

A Survey of Current Procurement Travel Practices, Accident Frequency, and Perceptions of Safety

“…We found that only 16% of our respondents utilized a recovery center during the past year and we believe this represents massive underutilization of a resource likely to drastically improve safety within the field. A very recent report by Lindemann et al 15 highlights further advantages of daytime-operating enabled by organ procurement centers including increased rates of extubation in the operating room and decreases in postoperative transfusion. The authors speculate that organ procurement centers will reduce transplant surgeon burnout and enhance recruitment of young surgeons into the field.…”