Image-Sharing Bronchoscopy: A Donor Management Advanced Practice Benefits Lung Donation.

Abstract

Background The feasibility to perform timely fiberoptic bronchoscopy (FOB) and the level of transplant center confidence in report of findings can impact donor care and lung utilization. For solution, selected Organ Procurement Organization (OPO) staff were trained and equipped to perform FOB and capture digital images of airway exam for broad sharing through Donor Net upload. Clinical impact of this OPO initiative is examined relative to conventional FOB practice. Methods FOB curriculum development and training were carried out in collaboration with the American College of Chest Physicians and airway exam performed using the MAF-TM-SET Olympus Airway Mobilscope with integral digital camera and light source. Findings were shared as text reports (hospital performed FOB) or uploaded digital images (OPO performed FOB). The data set was collected from 70 sequential FOBs for each cohort accrued over 8 month periods. Results All 70 OPO FOBs were collectively performed by five trained staff with no adverse events. Outcome between groups is shown [table 1]. Age and gender composition were comparable. The OPO practice was associated with significantly more after-hours procedures, repeat FOB capability (at 20%) for pulmonary toilet, higher level of intent, and cost containment. There were more lung donors and lungs transplanted in the OPO group, but did not reach statistical significance. Table 1. Summary of Bronchoscopy Outcome Hospital (N=70)OPO (N=70)Changep ValueAge (Years)3632 0.082Male (%)37 (53%)43 (61%)6 (8%)0.6743After Hours FOB15 (21%)49 (70%)34 (49%)0.0004Repeat FOB014 (20%)14 (20%)0.0001Intent27 (39%)49 (70%)22 (31%)0.0236OR Decline3960.1337Lung Donors23 (33%)35 (50%)12 (17%)0.2121 Double Lung192670.3949 Single Lung4950.2491 Total Lungs426119 (45%)0.1928FOB Costs$93,590 $16,730 ($76,860)0.0001 Conclusion Image-sharing FOB performed by trained OPO staff is a safe, cost containment practice which permits timely and repeat examination upon need, and is an effective means to permit remote viewing of the donor airway all to support lung donor management and utilization.