The impact of meeting donor management goals on the number of organs transplanted per donor: Results from the United Network for Organ Sharing Region 5 prospective donor management goals study

摘要

OBJECTIVE: Many organ procurement organizations have implemented critical care end points as donor management goals in efforts to increase organs transplanted per donor after neurologic determination of death. Although retrospective studies have demonstrated an association between meeting donor management goals and organ yield, prospective studies are lacking. DESIGN: In June 2008, nine donor management goals were prospectively implemented as a checklist and every donor after neurologic determination of death was managed to meet them. The donor management goals represented normal cardiovascular, pulmonary, renal, and endocrine end points. Data were collected for 7 months. Donor management goals "met" was defined a priori as achieving any seven of the nine donor management goals, and this was recorded at the time of consent, 12-18 hrs later, and prior to organ recovery. The primary outcome measure was ≥4 organs transplanted per donor, and binary logistic regression was used to identify independent predictors of this outcome with a p <.05. SETTING: All eight organ procurement organizations in the five Southwestern United States (United Network for Organ Sharing Region 5). SUBJECTS: All standard criteria donors after neurologic determination of deaths. INTERVENTION: Prospective implementation of a donor management goal checklist. MEASUREMENTS AND MAIN RESULTS: There were 380 standard criteria donors with 3.6±1.7 organs transplanted per donor. Fifteen percent had donor management goals met at the time of consent, 33% at 12-18 hrs, and 38% prior to organ recovery. Forty-eight percent had ≥4 organs transplanted per donor. Donors with ≥4 organs transplanted per donor had significantly more individual donor management goals met at all three time points. Independent predictors of ≥4 organs transplanted per donor were age (odds ratio =0.95 per year), final creatinine (odds ratio = 0.75 per 1-unit increase), donor management goals "met" at consent (odds ratio = 2.03), donor management goals "met" prior to organ recovery (odds ratio = 2.34), and a change in the number of donor management goals achieved from consent to 12-18 hrs later (odds ratio = 1.13 per additional donor management goal). CONCLUSIONS: Meeting donor management goals prior to consent and prior to organ recovery were both associated with achieving ≥4 organs transplanted per donor. However, only 15% of donors have donor management goals met at the time of consent. The donor hospital management of patients with catastrophic brain injuries, before the intent to donate organs is known, affects outcomes and should remain a priority in the intensive care unit.