Organ Procurement Organization Research Articles

Increasing Solid Organ Donation: A Role for Emergency Physicians

BackgroundMore than 100,000 Americans with failing organs await transplantation, mostly from dead donors. Yet only a fraction of patients declared dead by neurological criteria (DNC) become organ donors. DiscussionEmergency physicians (EPs) can improve solid organ donation in the following ways: providing perimortem critical care support to potential organ donors, promptly notifying organ procurement organizations (OPOs), asking neurocritical care specialists to evaluate selected emergency department patients for death based on established neurologic criteria, participating in research to advance these developments, implementing automatic OPO notification technologies, and educating the professional and lay communities about organ donation and transplantation, including exploration of opt-out (presumed consent) organ recovery policies. ConclusionWith future improvements in organ preservation and DNC assessment, EPs may become even more involved in the donation process. EPs should support and engage in efforts to promote organ donation and transplantation.

Early Effect of the Circular Model of Kidney Allocation in the United States.

In March 2021, the United States implemented a new kidney allocation system (KAS250) for deceased donor kidney transplantation (DDKT), which eliminated the donation service area-based allocation and replaced it with a system on the basis of distance from donor hospital to transplant center within/outside a radius of 250 nautical miles. The effect of this policy on kidney discards and logistics is unknown. We examined discards, donor-recipient characteristics, cold ischemia time (CIT), and delayed graft function (DGF) during the first 9 months of KAS250 compared with a pre-KAS250 cohort from the preceding 2 years. Changes in discards and CIT after the onset of COVID-19 and the implementation of KAS250 were evaluated using an interrupted time-series model. Changes in allocation practices (biopsy, machine perfusion, and virtual cross-match) were also evaluated. Post-KAS250 saw a two-fold increase in kidneys imported from nonlocal organ procurement organizations (OPO) and a higher proportion of recipients with calculated panel reactive antibody (cPRA) 81%-98% (12% versus 8%; P <0.001) and those with >5 years of pretransplant dialysis (35% versus 33%; P <0.001). CIT increased (mean 2 hours), including among local OPO kidneys. DGF was similar on adjusted analysis. Discards after KAS250 did not immediately change, but we observed a statistically significant increase over time that was independent of donor quality. Machine perfusion use decreased, whereas reliance on virtual cross-match increased, which was associated with shorter CIT. Early trends after KAS250 show an increase in transplant access to patients with cPRA>80% and those with longer dialysis duration, but this was accompanied by an increase in CIT and a suggestion of worsening kidney discards.

The role of anesthesiologists in organ donation

With the continued deficit of available organs for transplantation, optimal care of the brain-dead and cardiac death donor is essential to optimize quality and quantity of precious organs. Anesthesiologists are a critical part of the perioperative surgical retrieval process, although individually, may rarely care for a donor. Prospective data to inform specific clinical practices is sparse although educational resources exist to guide anesthesiologists with ethical or clinical questions and protocols from intensive care units and organ procurement organizations serve as useful templates for maintenance of organ function. Pre-surgical resuscitation, optimization and homeostatic strategies should be continued into the operating room. Cautious titration of low dose anesthetic and analgesic agents may be required to blunt sympathetic and spinal reflexes but should not aggravate hypotension and muscle relaxation is recommended to facilitate surgical exposure. Anesthesiologists should be aware of procedural and pharmaceutical aspects of the donation process, including re-intubation of a deceased donor after death is confirmed when lung retrieval is planned.

No Stone Left Unturned: Utilization of an Organ Procurement Organization Donor Surgeon at Procurement Reduces Discards of Marginal Liver Allografts.

The recent trend of organ procurement organizations (OPOs) employing independent surgeons for organ procurement has been developed with the goal of improving the supply of suitable organs for transplantation. We investigated the effects that the addition of an OPO-employed, organ-procurement specialist has on liver allograft discard rate, marginal organ utilization, and graft survival. Organ Procurement and Transplant Network and OPO data were retrospectively studied between April 1, 2014' and July 31, 2019' within the Southwest Transplant Alliance donor service area. Liver procurements with an OPO-surgeon present (OPO-Present) were compared to those without the involvement of an OPO surgeon (OPO-Absent). Donor and recipient characteristics as well as outcomes were analyzed across groups using propensity score matching. In total 869 OPO-Present liver allografts had similar rates of discard (5.2%) compared to 771 OPO-Absent livers (5.8%). However, after adjusting for donor risk, OPO-Present livers had a lower propensity of discard compared to OPO-Absent (3.4% versus 7.6%, P < 0.05). OPO-Present livers were more likely to be shared nationally (11.0% versus 4.8%, P < 0.001). Outcome analysis showed allograft survival of OPO-Present livers at 5 y was comparable to OPO-Absent livers (79.5% versus 80%, P = 0.34). The presence of an OPO surgeon was associated with decreased liver allograft discard and increased utilization of marginal donor organs. The OPO surgeon's presence represents a potential strategy to increase organ utilization nationally.

Aspects of the CPRRD Affecting Xenotransplantation Research in Human Heart-beating Brain-dead Decedents.

Aspects of the CPRRD Affecting Xenotransplantation Research in Human Heart-beating Brain-dead Decedents.

The New Distance-Based Kidney Allocation System: Implications for Patients, Transplant Centers, and Organ Procurement Organizations.

Purpose of ReviewThe goal of deceased donor kidney allocation policy is to provide objective prioritization for donated kidneys, and policy has undergone a series of revisions in the past decade in attempt to achieve equity and utility in access to kidney transplantation. Most recently, to address geographic disparities in access to kidney transplantation, the Kidney Allocation System changed to a distance-based allocation system—colloquially termed “KAS 250”—moving away from donor service areas as the geographic basis of allocation. We review the early impact of this policy change on access to transplant for patients, and on complexity of organ allocation and transplantation for transplant centers and organ procurement organizations.Recent FindingsBroader sharing of kidneys has increased complexity of the allocation system, as transplant centers and OPOs now interact in larger networks. The increased competition resulting from this system, and the increased operational burden on centers and OPOs resulting from greater numbers of organ offers, may adversely affect organ utilization. Preliminary results suggest an increase in transplant rate overall but a trend toward higher kidney discard and increased cold ischemia time.SummaryThe KAS 250 allocation policy changed the geographic basis of deceased donor kidney distribution in a manner that is intended to reduce geographic disparities in access to kidney transplantation. Close monitoring of this policy’s impact on patients, transplant center behavior, and process measures is critical to the aim of maximizing access to transplant while achieving transplant equity.

The Impact of Organ Procurement Injury on Transplant Organ Availability

Patients on the transplant waiting list continue to have a significant wait time as organ supply remains low. Many initiatives have been undertaken in the last few years to attempt to increase the organ allograft supply. As organ procurement organizations have attempted to increase their procurement of organs from deceased donors, emphasis has been placed on avoidance of injury to organs during procurement. To analyze the success of this attention, data were collected from 29 of 57 organ procurement organizations in the United States. Data collection was from November 2017 to January 2020. Total injury rate ranged from 6% (donation after brain death) to 8.4% (donation after circulatory death). Level 3 injuries, those resulting in loss of the allograft, ranged from 1.1% in donation after brain death to 1.6% in donation after circulatory death. The most likely injured organ resulting in loss of viability (level 3 injury) during procurement was the right kidney. We noted that among donors with procurement injuries, a higher number had no previous abdominal surgery and there were more injuries noted from attending surgeons (compared to trainees). Deceased donor procurement organ injuries, though rare, lead to substantial loss of transplantable organs every year. Given that the United Network for Organ Sharing has recorded >10,000 deceased donors yearly for the past few years, such injuries can result in hundreds of transplantable organs lost. In this article we detailed the incidence and degree of injury and some variables that may be associated with these injuries.

Location of organ procurement and distribution organisation decisions and their impact on kidney allocations: a developing country perspective.

Managing organ transplant networks is a complex task. It intertwines between locating the organ procurement and distribution organization (OPDO) (long-term decision) and allocating organs to the suitable destination (short-term decision). The literature lacks deliberation on the effect of those long-term decisions on short-term ones under the influence of clinical and non-clinical factors. This paper addresses this gap using a k-sum model for locational choice, and a discrete simulation approach for the allocation procedure for a real-life case study from a developing economy perspective. The study explores the trade-off between efficiency (distance-centric models) and equity (the result of time-centric allocation models). Our analysis of the efficiency of locational models and equity of the allocation policies reveal strong inter-dependence of both these decisions, a significant finding of this research. These findings offer an integrated model for high-level decision-makers, which can be used during the locational planning stage and provide input to design standard operating procedures for transplantation schemes.

Outcomes of a High-Volume Organ Procurement Organization in the Era of Increasing Donation After Circulatory Death.

Introduction: Donation after circulatory death (DCD) is rapidly increasing in the United States. Detailed data outlining the process from referral to organ transplantation is lacking. Project Aims: We sought to quantify differences at each stage along the referral to donation pathway by donor type. Additionally, we examined factors associated with successful DCD organ utilization. Design: This program evaluation analyzed data from a single organ procurement organization in 2018 to assess demographic and clinical predictors of progression through the donation process, including the role of first-person authorization in DCD. Descriptive statistics were examined by donation stage for demographic characteristics using chi-square; univariate and multivariate logistic regression was used to model predictors of utilization and authorization by organ type, respectively. Results: There were 2466 organ donation referrals during 2018, including 575 donations after brainstem death (DBD), 1890 controlled DCD referrals, and 1 uncontrolled DCD referral. Univariate and multivariate logistic regression models highlighted differences in authorization rates by donor type (DCD vs DBD) and by age, race, and ethnicity. Next-of-kin authorization was declined in 23% of first-person authorized potential DCD, highlighting issues related to the role of donor registration in DCD. Pre-mortem heparin administration was predictive of DCD organ utilization; donor age and warm ischemia time of less than 30 min was statistically significantly associated with DCD extra-renal organ utilization. Conclusion: These results provided insight into strategies for increasing authorization and transplantation of organs from DCD donors and identified areas of improvement for process standardization and policy development.

A Review of Practices Around Determination of Death by Neurologic Criteria by an Organ Procurement Organization in the WAMI Region.

To examine the verification of a referring hospital's practice of determining death by neurologic criteria (DNC) by an organ procurement organization (OPO) pursuant to the Center for Medicaid and Medicare Services rule §486.344(b). In this retrospective cohort study, we examined prevalence and factors associated with deviations from acceptable DNC standards, the performance of additional ancillary testing requested by the OPO, resolution of concerns about deviations between referring hospitals and the OPO, and interactions between referring hospitals and the OPO. The OPO reviewed DNC processes for 645 adult potential organ donors from 64 referral hospitals. Concerns about practice deviations from acceptable standards were identified by the OPO's medical director (also a practicing neurointensivist) on call in 19% (n = 120) and were related to clinical prerequisites (27.2%, n = 49), clinical examination (23.9%, n = 67), and apnea testing (25.3%, n = 97). The top 3 concerns were apnea test results not meeting PCO2 targets (6.7%, n = 43), errors in documentation of the clinical examination (5.3%, n = 34), and potential confounding effects of CNS depressants (2.5%, n = 16). Compared with the "no medical director concerns" group which includes all patients, where the coordinator felt that DNC determination met all the conditions on the checklist, medical director concerns were less likely to occur in hospitals with a dedicated neurocritical care unit (odds ratio [OR] 0.33, 95% CI 0.17-0.66, p < 0.001), prevalent across hospitals independent of whether their policies conformed to updated DNC guidelines (OR 0.92, 95% CI 0.57-1.45, p = 0.720). The OPO requested additional ancillary testing (6%, n = 41) when clinical prerequisites were not met (OR 12.7, 95% CI 4.29-33.5), p < 0.001). Resolution of concerns and organ donation was achieved in 99.4% (n = 641). Four patients were rejected as brain-dead donors because of the presence of cerebral blood flow on the nuclear medicine perfusion test. Referring hospitals requested support from the OPO regarding the determination of DNC (10%, n = 64) and declaring physicians were reported to lack knowledge about the institutional DNC policy (4%, n = 23). Ongoing review of institutional DNC standards and adherence to those standards is an urgent unmet need. Both referring hospitals and OPOs jointly carry responsibility for preventing errors in DNC leading up to organ recovery.

341.1: Examining One Procurement Organization’s Growth: Riding Coattails or Innovating?

The need for organ donation remains great in the U.S. Despite continued and sustained growth in donation and transplantation numbers nationally, over 106,000 people remain on the waitlist as of this publication (Organ Procurement and Transplant Network Data, 2022). Some have hypothesized that the recent growth in organ donation is a direct result of organ procurement organizations (OPO) “riding the coattails of a national tragedy” (D Goldberg, R Lynch), suggesting that in some areas, OPO growth is correlated with the rise in opioid overdose deaths. It is a fact that all too often overdoses result in cardiac arrests and subsequent anoxic brain injury that leads to brain death (BD) or the family making the difficult decision to withdraw life sustaining therapy. When this happens, donation does become an option that is presented to the family. One OPO took a deep dive into their data to understand what was driving their own OPO’s growth and to examine if this suggested trend existed in their donation service area. A 4-year retrospective data review was completed, and donors were categorized by donor type (BD vs DCD), age, and cause of death. Any donor whose cause of death (n=304) was listed as anoxia was examined closely and classified by the cause of the anoxic injury. Nine primary causes for anoxic brain injury emerged in the data. This OPO saw a 24% growth in organ donors from 2018 to 2021. This growth was realized by growing their DCD donor population by 96%, from 57 donors in 2018 to 112 donors in 2021. Of the 112 DCD donors in 2021, 5.4%% (6) donors had life sustaining therapy withdrawn because of a devastating anoxic injury that was secondary to an overdose. Of the 304 combined BD and DCD donors with anoxic injury as their cause of death during the four-year study period, 13.8% of the anoxic injuries were the result of drug intoxications. Looking at all 832 donors for the same period, overdose represented just 5% of the total donor population from this OPO. This OPO made DCD donation a strategic priority and has invested heavily in staffing, technology, and resources to increase the number of donors and lifesaving organs made available. As a result, this OPO has had record growth and has been a national leader in DCD donation. Interestingly, a query of the CDC WONDER database for inpatient overdose deaths suggest that numbers are stagnant in this OPO’s services area (Centers for Disease Control and Prevention). The growth experienced by this OPO is a result of hard work at all levels of the donation process to maximize every opportunity for donation, not riding the coattails of a national drug overdose epidemic.

233.2: Aftercare for Organ Donor Families: A Content Analysis of Organ Procurement Organization Family Services and Educational Materials

Purpose: Following a sudden and tragic loss, organ donor families’ members experience grief, and may even develop prolonged grief disorder. All US organ procurement organizations (OPOs) provide family support and aftercare services for organ donor families, but the breadth and focus of services vary across OPOs. We assessed the scope and gaps of existing donor family services in the US and its territories. Methods: Family service offerings were identified through each OPOs website (n =57), (Table 1). We used qualitative content analysis to identify topics covered and delivery format; 11 categories were developed inductively based on common services offered by OPOs. The frequency of each service was reported and analyzed using descriptive statistics. Results: Categories of existing donor family services and educational materials included written materials, podcasts, blogs, social media, support groups, provider referrals (referring individuals to specific counselors), on-site counseling, counseling and support services (providing websites and phone numbers to local counseling/support services), family/recipient connections, and celebratory and honorary events (Table 1). Of all services, celebratory and honorary events as well as written materials were universally provided by OPOs (100%). Quilts made in honor of donors were commonly provided by OPOs, in which the donor families can submit a quilt square commemorating their loved one. A third to nearly a half of OPOs offered donor family services such as ‘Social Media,’ ‘Blogs,’ ‘Videos’ and’ ‘Podcasts.’ Social media support services were often offered through Facebook groups to create a sense of community for donor families. Family/recipient connections (98%) and counseling recommendations (86%) were commonly offered, while provider referrals, support groups, and on-site counseling were offered by less than 20% of OPOs. Conclusion: Counseling and support services for organ donor families vary by OPO and can be improved. The development and implementation of evidence-based grief programs tailored to these families can improve quality of services to support donor families.

400.9: The First Independent Provincial OPO in China: Shanxi Experience

Introduction: While the reform of organ transplantation in China has achieved success, the organ procurement model for different regions in the country varies. Starting from a hospital-based organ procurement organization (OPO), Shanxi OPO was established as the first independent non-profit provincial OPO in China, which covers a donation area of 37.29 million population and serves 6 transplant hospitals in the region. Shanxi OPO was established in 2018 under the supervision of Shanxi provincial health commission. This study compares results before and after the establishment in regard to the quantity, quality and efficiency of organ donation and transplantation (OD & OT) within Shanxi Province, aiming at exploring a feasible and up-to-date procurement management mode in China. Method: From the point of organizational structure, personnel composition, equipment management and core quality indicators, we analyze the data from 2015 to 2021 and compare the results before and after the establishment of the provincial OPO. Results: In the past two years, a professional team with 7 departments has been built. Besides, advanced facilities like those for donor maintenance and information collection are equipped. Then in 2020, an ethics and scientific committee have been founded to guide scientific research and supervise ethical norm compliance. Through analyzing the quality control indicators, the number of OD has increased from 35 cases (PMP: 0.99) in 2015 to 126 cases (PMP: 3.61) in 2021, with an increase rate of 260%. The growth trend remains within Shanxi Province even under the influence of COVID-19 pandemic in 2020, while the case number of the country decreased. Since 2018, the number of organs procured from per donor and the organ utilization rate of Shanxi OPO have risen year by year, reaching 3.02 and 98.7% respectively in 2021. Moreover, the DBD rate has increased from 1.1% in 2019 to 20.63% in 2021, though there is still a gap compared to the national and international level. These positive changes indicate that the quality of our service in organ viability assessment, donor maintenance, organ recovery and coordination have been gradually improved. Conclusion: Efficiency and quality of the organ procurement and allocation have been greatly improved in the past few years because of the establishment of Shanxi OPO. This kind of provincial OPO also provides a solution, which will lead a clear direction for the standardization of organ procurement in China.

233.5: Grant Funding to Support Increased Access to Transplant Care for Patients and Caregivers

Introduction: Patients experiencing end-stage organ failure face many challenges that can result in financial distress for the patient and caregiver. Financial distress can limit access to transplant care, which has become an increasing concern as the transplant list continues to grow and disparities in access are highlighted. Our region’s Organ Procurement Organization (OPO)’s affiliated transplant hospitality house supports the lodging, transportation and support needs of patients traveling into one city for treatment at its 7 city transplant centers. The remaining transplant Regional Centers (RC) in the OPO region are located outside of the city in areas not supported by the hospitality house. Interviews with RCs highlighted that RCs’ transplant patients needed assistance for travel and lodging to support access to transplant care. Method: The OPO affiliated Foundation established The Transplant Center Family Support Grant Program through which 9 RCs can apply for up to $25,000 a year to support their patients’ travel, lodging and food needs related to their transplant care. Each RC application was vetted and approved based on the grant guidelines. Approved applicants were required to implement systems for releasing and tracking disbursed funds and submit quarterly logs with de-identified information on utilization. Results: Between 2019-2021, 9 hospitals received a total of $313,371. Grant funds were distributed to 1,947 non-unique, patient/caregiver units (Pt/CGs), totaling $236,636 in utilization and an average of $121 per distribution. Of the $236,636, $135,736(57%) was utilized for transportation support, $82,126(35%) was utilized for lodging support, $18,237(8%) was utilized for food support, and the remaining was other. Of the 1,947 Pt/CGs receiving funds, 1,517 were to kidney Pt/CGs(78%), 279 were for liver Pt/CGs(14%), and 75 were for heart Pt/CGs(4%). The primary reason for the Pt/CG support was as follows: 591(30%) were for Pt/CGs evaluation to be listed and 569(29%) for post-transplant appointments. Pt/CGs utilizing funds for transplant surgery was 289(15%) and the remaining(less than 10%) for each pre-transplant appointment (once listed), hospitalization (not for transplant surgery), or left blank. Based on the 3-year data, transportation support was the most significant need for Pt/Cgs. Similarly, kidney Pt/CGs presented most frequently with the largest need to facilitate evaluation and post-transplant appointments. Conclusion: The Regional Centers Grant Program is just one example of a program that may enhance access to care, especially for Pt/CGs with limited means and difficulty accessing transportation, lodging and food. Further examination should be done of this program and other innovative programs to support access to care, particularly for those facing financial and other barriers to determine impact and effectiveness and promote equity in transplant care.

247.3: Utility of Liver Biopsy in Liver Transplantation: Implications for Changes in Liver Allocation

Introduction: Histological evaluation of a potential donor liver can provide useful information prior to liver transplantation (LT) and potentially reduce discard rates. However, the use of a liver biopsy (LB) is not standardized across Organ Procurement Organizations. On February 4, 2020, the LT allocation policy in the United States changed, likely shifting institutional and regional behavior changes for the acceptance of donated organs. We sought to review LB utilization patterns before and after the institution of the acuity circle allocation system (ACAS) and determine if LB rates were associated with allograft discard rates, patient and graft survival. Methods: Data from the Scientific Registry of Transplant Recipients (SRTR) were analyzed on the utilization of LB before and after the implementation of ACAS. Era 1 was defined as January 1, 2018 to February 3, 2020; Era 2 was defined as February 4, 2020 to June 1, 2021. Statistical comparisons between eras were performed. Univariable and multivariable models were constructed to determine donor characteristics that were correlated with obtaining a LB during the eras. Kaplan-Meier survival analysis was performed to determine the impact of LB on patient and graft survival. Results: We analyzed 29,905 liver transplants performed from January 1, 2018 to June 1, 2021; 17,949 (60%) were performed in Era 1 and 11,956 (40%) were performed in Era 2. During the study time period, there were 11,043 LB performed; 6,488 (58.8%) in Era 1 and 4,555 (41.2%) in Era 2 (p<0.001). Era 1 demonstrated a LB rate of 36.1% while Era 2 demonstrated a LB rate of 38.1% (p<0.001). Donor characteristics associated with obtaining a LB were BMI, race, age, history of DM, and era. The discard rate between Era 1 (15.8%) and Era 2 (15.0%) did not differ (p=0.097). The 1- and 3-year patient survival for LT recipients was 93.3% and 83.5%, resp., and graft survival during Era 1 was 96.7% and 94.4%, respectively. The 1-year patient survival for LT recipients during Era 2 was 89.9% and graft survival was 96.1%. Conclusion: The institution of the ACAS led to differing acceptance practices around liver transplantation. In the time period after institution of the model, there was a statistically significant increase in utilization of LB, likely due to wider catchment areas for potential recipients. ACAS seemed to have no effect on the rates of allograft discard rates, patient, or graft survival.

400.3: One Organ Procurement Organization’s Effective Strategy For Dramatically Increasing Donation After Circulator Death Donation and Transplantation

400.3: One Organ Procurement Organization’s Effective Strategy For Dramatically Increasing Donation After Circulator Death Donation and Transplantation

P13.02: Significant Fall in Living Donation Rates of Pediatric Kidney Transplants in Puerto Rico

Introduction: Living donation (LD) offers superior outcomes compared to deceased donor (DD) transplantation for patients with ESRD. In the US, an increment in LD rate was observed until 2001 and 2004, when LD rates began to decrease in peds and adult renal transplants (KTx), respectively. Knowledge about LD trends among children who have received KTx in PR is limited. We describe LD trends among pediatric KTx performed in PR from 1977-2013. Methods: Retrospective chart review of all children (0-18yrs) receiving KTx in PR from 1977-2013. Median (range) frequencies (percentages) were calculated. Results: From 1977-2013, 146 children, female: 39%, Hispanic: 100%, age: 14yrs (2-18yrs) were transplanted. 60% received LD and 40%DD. 75%LD were parents, 13%LD siblings, and 1%LD unrelated. 16%DD were from the US. Total number of transplants remained stable from 1980-2000 (1977-79: 5 KTx, 1980’s: 40 KTx, 1990’s: 40 KTx, 2000’s: 45 KTx, 2010-13: 16 KTx). LD rate decreased over time (77-79: 100%, 80’s: 85%, 90’s: 75%, 00’s: 31%, 10-13: 12%). 6%pts received 2nd KTx at 21yrs or younger, with 67% and 33% LD on 1st and 2nd KTx, respectively. Of these pts, female: 44%, age at first KTx: 12yrs(5,18yrs), and age at 2nd KTx: 17yrs(13-21yrs). Conclusions: Living donation in pediatric renal transplants has substantially declined in PR over the last 4 decades. Possible explanations include single parenting, medical unsuitability, shifting practice patterns (i.e. establishment of solid organ procurement organizations), and marketing strategies, among others. Additional studies are needed to better understand the causes of such decline and to develop strategies to increase LD among our children with ESRD. Research reported in this publication was supported by the Hispanic Center of Excellence U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce University of Puerto Rico School of Medicine (Grant Number D34HP24463) and the National Institutes of Health (Award Number U54GM133807-01A1). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

341.8: Current Development Strategy of Organ Procurement Organization in China

341.8: Current Development Strategy of Organ Procurement Organization in China

P1.01: Optimizing Lung Function During Donor Management Through A Multidisciplinary Approach

Introduction: In current healthcare, a multi-disciplinary approach is taken in critical care to ensure all specialties can offer their training and expertise in the care of every patient. In organ donation, and specifically donor management, having a team of Procurement Transplant Coordinators (PTCs) that is comprised similarly ensures that optimal results can be achieved through a varied knowledge base. Traditionally, this has been heavily weighted with Registered Nurses with critical care experience. We propose that including Registered Respiratory Therapists (RRTs) as PTCs can broaden the base of expertise of the team and maximize successful lung transplantation. Additionally, the incorporation of different modes and modalities of ventilation with a physiological approach to lung recruitment has successfully proven an increase in lung optimization. Method: To fully understand the positive impact of RRTs in lung recruitment, we looked at the upward trend of the Horowitz index for Lung Function (P/F ratio) with a subject United States based Organ Procurement Organization and how it correlated with an increasing number of PTCs that are licensed and registered Respiratory Therapists. Four RRTs were onboarded to the donor management team during 2020 and 2021. Comparing the results from previous years, data showed a related increase in lung recruitment and optimization per year with RRTs working as PTCs. Results: Evidence demonstrated a correlation of the increase in lung procurement and transplantation numbers mirroring an increase in RRTs in the role of PTCs. Improvements to P/F ratios were compared at the beginning of the case to the final P/F ratio prior to OR. From January 1, 2018-December 31, 2019 there were 89 donors who were brought to the operating room for lung procurement with the intent of transplant. The median and mean improvement to P/F ratios were +0.83 and +0.83, respectively. From January 1, 2020- December 31, 2021 there were 75 donors who were brought to the operating room for lung procurement with the intent of transplant. The median and mean improvement to P/F ratios were +1.04 and +1.32, respectively. This proved a 25.3% increase for the median PF ratio and a 59% increase to the mean PF ratio. Conclusion: Our research supports that PTCs who are licensed and experienced Respiratory Therapists being proficient in lung physiology, recruitment, and ventilation strategies contribute to an increase in lung optimization. With having specific organ expertise, RRTs have proven to be a vital asset while sharing knowledge with the entire multi-disciplinary team.

Kidney nonprocurement in deceased donors with acute kidneyinjury.

Acute kidney injury (AKI) is common in deceased organ donors and is associated with high rates of kidney discard by transplant centers. High discard rates may consequently drive nonprocurement of these kidneys by organ procurement organizations. We aimed to study the relationship between donor AKI and kidney nonprocurement. Using U.S. registry data, we identified donors with at least one organ recovered from 2008 to 2018. We compared characteristics of donors with no kidneys procured across AKI stages, and used multivariable logistic regression to evaluate the relationship between AKI severity and kidney nonprocurement. Overall 14543 kidneys from 7620 donors were not procured, among which 93% were from donors with AKI. For 6945 donors with no kidneys procured but an extrarenal organ recovered, most had stage 3 (51%), followed by stage 1 (27%) and stage 2 AKI (15%). Nonprocured stage 3 donors were the youngest and had the lowest Kidney Donor Risk Index of all nonprocured donors. Adjusted odds of kidney nonprocurement were 1.14 (95%CI 1.02-1.27) for stage 1, 1.25 (95%CI 1.12-1.41) for stage 2, and 10.37 (95%CI 9.30-11.56) for stage 3 donors, compared to non-AKI donors. Among donors with minimum creatinine <1.5mg/dl, stage 2 and 3 AKI were still associated with significantly higher odds of nonprocurement. AKI severity is a strong risk factor for kidney nonprocurement. Efforts to address the organ shortage should focus on encouraging procurement and utilization of kidneys from deceased donors with severe AKI, given the large and rising prevalence of donor AKI and excellent transplant outcomes with these kidneys.