Organ Care System Pathway.

Abstract

PURPOSE Lung transplantation using the Organ Care System (OCS) requires the management of several well- orchestrated processes. We describe the implementation and conduct of OCS at a single institution with an emphasis on process improvement initiatives to reduce errors. METHODS A global OCS checklist is utilized by our donor coordinators after an organ is deemed appropriate for OCS. This list was devised by the surgeons and coordinators with help from the manufacturer. If a donor and a recipient meet inclusion criteria for OCS, the recipient is called and the consent is verified. The hospital pharmacy and blood bank are called and issue appropriate medications and blood products. All additives are pre-drawn by our pharmacist. The procuring surgeons and perfusionists are trained with simulation courses and must have 5 supervised runs prior to assuming independence. The team gathers 30 minutes prior to departure for setup. The device is assembled with the batteries, ventilation gas tanks, mechanics and software checks. A final checklist is used prior to leaving the emergency department. All ground and air transport has been assessed before-hand to ensure that size and safety requirements are met. At the donor hospital, the final organ acceptance takes place with the use of an on-site donor assessment checklist. The OCS is primed and prepared for accepting the lungs which are procured, instrumented and placed in the device. During transport they are ventilated and perfused. At the recipient hospital final verification and assessment takes place prior to implantation. OCS is disassembled and prepared for the next case, with tanks, batteries and software checkups. RESULTS Five organs transplanted on OCS have been free of primary graft dysfunction 3 (PGD3) at 72 hours post- transplant. With implementation of the global and the final checklist for OCS Pathway we avoided over five near miss events. CONCLUSION OCS offers the potential for improved organ preservation and donor utilization. Standardization of the OCS procurement process with the use of critical checklists aids in reducing near miss events.