The impact of meeting donor management goals on the number of organs transplanted per expanded criteria donor: A prospective study from the UNOS region 5 donor management goals workgroup

Madhukar S. Patel, John Zatarain, Salvador De La Cruz, Mitchell B. Sally, Tyler Ewing, Megan Crutchfield, C. Kristian Enestvedt, Darren J. Malinoski

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

IMPORTANCE The shortage of organs available for transplant has led to the use of expanded criteria donors (ECDs) to extend the donor pool. These donors are older and have more comorbidities and efforts to optimize the quality of their organs are needed.

OBJECTIVE To determine the impact of meeting a standardized set of critical care end points, or donor management goals (DMGs), on the number of organs transplanted per donor in ECDs.

DESIGN, SETTING, AND PARTICIPANTS Prospective interventional study from February 2010 to July 2013 of all ECDs managed by the 8 organ procurement organizations in the southwestern United States (United Network for Organ Sharing Region 5).

RESULTS There were 671 ECDs with a mean (SD) number of 2.1 (1.3) organs transplanted per donor. Ten percent of the ECDs had met the DMG bundle at referral, 15%at the time of authorization, 33%at 12 to 18 hours, and 45%prior to recovery. Forty-three percent had 3 or more organs transplanted per donor. Independent predictors of 3 or more organs transplanted per donor were older age (odds ratio [OR] = 0.95 per year [95%CI, 0.93-0.97]), increased creatinine level (OR = 0.73 permg/dL [95%CI, 0.63-0.85]), DMGs met prior to organ recovery (OR = 1.90 [95%CI, 1.35-2.68]), and a change in the number of DMGs achieved from referral to organ recovery (OR = 1.11 per additional DMG [95%CI, 1.00-1.23]).

CONCLUSIONS AND RELEVANCE Meeting DMGs prior to organ recovery with ECDs is associated with achieving 3 or more organs transplanted per donor. An increase in the number of critical care end points achieved throughout the care of a potential donor by both donor hospital and organ procurement organization is also associated with an increase in organ yield.

INTERVENTIONS Implementation of 9 DMGs as a checklist to guide the management of every ECD. The DMGs represented normal cardiovascular, pulmonary, renal, and endocrine end points. Meeting the DMG bundle was defined a priori as achieving any 7 of the 9 end points and was recorded at the time of referral to the organ procurement organization, at the time of authorization for donation, 12 to 18 hours later, and prior to organ recovery.

MAIN OUTCOMES AND MEASURES The primary outcome measurewas 3 or more organs transplanted per donor and binary logistic regression was used to identify independent predictors with P

Original languageEnglish (US)
Pages (from-to)969-975
Number of pages7
JournalJAMA Surgery
Volume149
Issue number9
DOIs
StatePublished - Sep 1 2014
Externally publishedYes

Fingerprint

Tissue and Organ Procurement
Odds Ratio
Prospective Studies
Referral and Consultation
Critical Care
Southwestern United States
Checklist
Comorbidity
Creatinine
Logistic Models
Transplants
Kidney
Lung

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

The impact of meeting donor management goals on the number of organs transplanted per expanded criteria donor : A prospective study from the UNOS region 5 donor management goals workgroup. / Patel, Madhukar S.; Zatarain, John; De La Cruz, Salvador; Sally, Mitchell B.; Ewing, Tyler; Crutchfield, Megan; Enestvedt, C. Kristian; Malinoski, Darren J.

In: JAMA Surgery, Vol. 149, No. 9, 01.09.2014, p. 969-975.

Research output: Contribution to journalArticle

Patel, Madhukar S. ; Zatarain, John ; De La Cruz, Salvador ; Sally, Mitchell B. ; Ewing, Tyler ; Crutchfield, Megan ; Enestvedt, C. Kristian ; Malinoski, Darren J. / The impact of meeting donor management goals on the number of organs transplanted per expanded criteria donor : A prospective study from the UNOS region 5 donor management goals workgroup. In: JAMA Surgery. 2014 ; Vol. 149, No. 9. pp. 969-975.
@article{4149c735050a4995984cf378475be469,
title = "The impact of meeting donor management goals on the number of organs transplanted per expanded criteria donor: A prospective study from the UNOS region 5 donor management goals workgroup",
abstract = "IMPORTANCE The shortage of organs available for transplant has led to the use of expanded criteria donors (ECDs) to extend the donor pool. These donors are older and have more comorbidities and efforts to optimize the quality of their organs are needed.OBJECTIVE To determine the impact of meeting a standardized set of critical care end points, or donor management goals (DMGs), on the number of organs transplanted per donor in ECDs.DESIGN, SETTING, AND PARTICIPANTS Prospective interventional study from February 2010 to July 2013 of all ECDs managed by the 8 organ procurement organizations in the southwestern United States (United Network for Organ Sharing Region 5).RESULTS There were 671 ECDs with a mean (SD) number of 2.1 (1.3) organs transplanted per donor. Ten percent of the ECDs had met the DMG bundle at referral, 15{\%}at the time of authorization, 33{\%}at 12 to 18 hours, and 45{\%}prior to recovery. Forty-three percent had 3 or more organs transplanted per donor. Independent predictors of 3 or more organs transplanted per donor were older age (odds ratio [OR] = 0.95 per year [95{\%}CI, 0.93-0.97]), increased creatinine level (OR = 0.73 permg/dL [95{\%}CI, 0.63-0.85]), DMGs met prior to organ recovery (OR = 1.90 [95{\%}CI, 1.35-2.68]), and a change in the number of DMGs achieved from referral to organ recovery (OR = 1.11 per additional DMG [95{\%}CI, 1.00-1.23]).CONCLUSIONS AND RELEVANCE Meeting DMGs prior to organ recovery with ECDs is associated with achieving 3 or more organs transplanted per donor. An increase in the number of critical care end points achieved throughout the care of a potential donor by both donor hospital and organ procurement organization is also associated with an increase in organ yield.INTERVENTIONS Implementation of 9 DMGs as a checklist to guide the management of every ECD. The DMGs represented normal cardiovascular, pulmonary, renal, and endocrine end points. Meeting the DMG bundle was defined a priori as achieving any 7 of the 9 end points and was recorded at the time of referral to the organ procurement organization, at the time of authorization for donation, 12 to 18 hours later, and prior to organ recovery.MAIN OUTCOMES AND MEASURES The primary outcome measurewas 3 or more organs transplanted per donor and binary logistic regression was used to identify independent predictors with P",
author = "Patel, {Madhukar S.} and John Zatarain and {De La Cruz}, Salvador and Sally, {Mitchell B.} and Tyler Ewing and Megan Crutchfield and Enestvedt, {C. Kristian} and Malinoski, {Darren J.}",
year = "2014",
month = "9",
day = "1",
doi = "10.1001/jamasurg.2014.967",
language = "English (US)",
volume = "149",
pages = "969--975",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "9",

}

TY - JOUR

T1 - The impact of meeting donor management goals on the number of organs transplanted per expanded criteria donor

T2 - A prospective study from the UNOS region 5 donor management goals workgroup

AU - Patel, Madhukar S.

AU - Zatarain, John

AU - De La Cruz, Salvador

AU - Sally, Mitchell B.

AU - Ewing, Tyler

AU - Crutchfield, Megan

AU - Enestvedt, C. Kristian

AU - Malinoski, Darren J.

PY - 2014/9/1

Y1 - 2014/9/1

N2 - IMPORTANCE The shortage of organs available for transplant has led to the use of expanded criteria donors (ECDs) to extend the donor pool. These donors are older and have more comorbidities and efforts to optimize the quality of their organs are needed.OBJECTIVE To determine the impact of meeting a standardized set of critical care end points, or donor management goals (DMGs), on the number of organs transplanted per donor in ECDs.DESIGN, SETTING, AND PARTICIPANTS Prospective interventional study from February 2010 to July 2013 of all ECDs managed by the 8 organ procurement organizations in the southwestern United States (United Network for Organ Sharing Region 5).RESULTS There were 671 ECDs with a mean (SD) number of 2.1 (1.3) organs transplanted per donor. Ten percent of the ECDs had met the DMG bundle at referral, 15%at the time of authorization, 33%at 12 to 18 hours, and 45%prior to recovery. Forty-three percent had 3 or more organs transplanted per donor. Independent predictors of 3 or more organs transplanted per donor were older age (odds ratio [OR] = 0.95 per year [95%CI, 0.93-0.97]), increased creatinine level (OR = 0.73 permg/dL [95%CI, 0.63-0.85]), DMGs met prior to organ recovery (OR = 1.90 [95%CI, 1.35-2.68]), and a change in the number of DMGs achieved from referral to organ recovery (OR = 1.11 per additional DMG [95%CI, 1.00-1.23]).CONCLUSIONS AND RELEVANCE Meeting DMGs prior to organ recovery with ECDs is associated with achieving 3 or more organs transplanted per donor. An increase in the number of critical care end points achieved throughout the care of a potential donor by both donor hospital and organ procurement organization is also associated with an increase in organ yield.INTERVENTIONS Implementation of 9 DMGs as a checklist to guide the management of every ECD. The DMGs represented normal cardiovascular, pulmonary, renal, and endocrine end points. Meeting the DMG bundle was defined a priori as achieving any 7 of the 9 end points and was recorded at the time of referral to the organ procurement organization, at the time of authorization for donation, 12 to 18 hours later, and prior to organ recovery.MAIN OUTCOMES AND MEASURES The primary outcome measurewas 3 or more organs transplanted per donor and binary logistic regression was used to identify independent predictors with P

AB - IMPORTANCE The shortage of organs available for transplant has led to the use of expanded criteria donors (ECDs) to extend the donor pool. These donors are older and have more comorbidities and efforts to optimize the quality of their organs are needed.OBJECTIVE To determine the impact of meeting a standardized set of critical care end points, or donor management goals (DMGs), on the number of organs transplanted per donor in ECDs.DESIGN, SETTING, AND PARTICIPANTS Prospective interventional study from February 2010 to July 2013 of all ECDs managed by the 8 organ procurement organizations in the southwestern United States (United Network for Organ Sharing Region 5).RESULTS There were 671 ECDs with a mean (SD) number of 2.1 (1.3) organs transplanted per donor. Ten percent of the ECDs had met the DMG bundle at referral, 15%at the time of authorization, 33%at 12 to 18 hours, and 45%prior to recovery. Forty-three percent had 3 or more organs transplanted per donor. Independent predictors of 3 or more organs transplanted per donor were older age (odds ratio [OR] = 0.95 per year [95%CI, 0.93-0.97]), increased creatinine level (OR = 0.73 permg/dL [95%CI, 0.63-0.85]), DMGs met prior to organ recovery (OR = 1.90 [95%CI, 1.35-2.68]), and a change in the number of DMGs achieved from referral to organ recovery (OR = 1.11 per additional DMG [95%CI, 1.00-1.23]).CONCLUSIONS AND RELEVANCE Meeting DMGs prior to organ recovery with ECDs is associated with achieving 3 or more organs transplanted per donor. An increase in the number of critical care end points achieved throughout the care of a potential donor by both donor hospital and organ procurement organization is also associated with an increase in organ yield.INTERVENTIONS Implementation of 9 DMGs as a checklist to guide the management of every ECD. The DMGs represented normal cardiovascular, pulmonary, renal, and endocrine end points. Meeting the DMG bundle was defined a priori as achieving any 7 of the 9 end points and was recorded at the time of referral to the organ procurement organization, at the time of authorization for donation, 12 to 18 hours later, and prior to organ recovery.MAIN OUTCOMES AND MEASURES The primary outcome measurewas 3 or more organs transplanted per donor and binary logistic regression was used to identify independent predictors with P

UR - http://www.scopus.com/inward/record.url?scp=84907222978&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907222978&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2014.967

DO - 10.1001/jamasurg.2014.967

M3 - Article

C2 - 25054379

AN - SCOPUS:84907222978

VL - 149

SP - 969

EP - 975

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 9

ER -