ILTS 2012 Report – Meeting management goals among donors improves rates of organ use

by Thomas R. Collins – Establishing and adhering to management goals for organ donors boosts the percentage of livers that are utilized, researchers said here at the 18^th International Congress of the International Liver Transplant Society.

Darren Malinoski, MD, Associate Professor of Surgery and Director of Surgical Critical Care at Cedars-Sinai Medical Center in Los Angeles, said careful management of donor health conditions leading to transplant is an opportunity to boost the number of transplants and the number of successful transplants.

“We know that about 8 or 9 organs can be transplanted per donor in ideal situations — and the (U.S.) national average is only about 3,” he said.

Researchers in the Organ Procurement and Transplantation Network centers located in the Southwestern U.S. region prospectively analyzed liver utilization results when a list of donor management goals were met and when they were not met.

They looked at mean arterial pressure, central venous pressure, ejection fraction, vasopressor use, arterial blood gas, oxygen levels, serum sodium levels, glucose levels and urine output.

When the donor met the goal in any 7 of those 9 categories, researchers considered the “bundle” having been met.

They analyzed 961 brain-dead donors in their organ procurement region from 2008 to 2011.

When the “bundle” of management goals was met at the time the transplantation was authorized, the liver ended up being utilized 84 percent of the time. But when fewer than 7 of the goals were met, the liver was used only 74 percent of the time. The same results were found when the 9 categories were measured at the time of organ recovery, and were similar to when they were measured 12 to 18 hours after transplant authorization.

At the time of authorization, the categories that were significantly associated with graft utilization were oxygen levels and glucose levels.

At the other two time points — 12 to 18 hours after authorization and time of organ recovery — central venous pressure, ejection fraction and oxygen levels were significantly linked to utilization rates, the researchers found.

“Care provided by donor hospital teams may affect outcomes even in the recipient,” Dr Malinoski said.

The care of brain-dead donors is an interesting niche, he said, because the patients are deceased and “the amount of medical oversight and research surrounding their care is not the same as the rest of our patients. And so organ procurement organizations have varying degrees of medical oversight.”

“If you could standardize at least the checklist or the critical care endpoints that are being targeted at the bedside you might be able to get standardization, you might get some improvements in care,” Dr Malinoski said.

And, if centres all tended to do something similar, he said, at least there might be “a framework for good research in the future.”

Dr Malinoski said keeping track of the management of donors might lead to healthy competition among health centres.

“[Transplant centres] can’t tell them what to do prior to authorization,” he said. “But some of the hospitals want to compete with each other — ‘Well, that hospital did a better job than we did’ — and they adjust their critical care pathways and practices.”