Reasons For Discard Research Articles

Factors that influence discarding in the Gulf of Mexico commercial grouper-tilefish IFQ reef fish fishery

Factors potentially affecting fish discarding were evaluated for species managed under the Gulf of Mexico grouper-tilefish individual fishing quota (GT-IFQ) program. Thirteen commercially important species are managed under the GT-IFQ program. Some of the more commonly caught species in the program include red grouper (Epinephelus morio), gag (Mycteroperca microlepis), speckled hind (Epinephelus drummondhayi), golden tilefish (Lopholatilus chamaeleonticeps), and blueline tilefish (Caulolatilus microps). It is necessary to determine why discards are occurring to develop a future discard mitigation strategy. Logistic models were constructed using data from the Southeast Fisheries Science Center’s (SEFSC) Reef Fish Observer Program (RFOP) with covariates of fish length, available allocation, gear type, calendar year quarter, and year to infer reasons for discarding. The results from RFOP models in conjunction with self-reported discard information from the SEFSC Supplemental Discard Logbook program determined that discarding due to fish length selection, not related to minimum a size limit, is occurring for golden tilefish, speckled hind, yellowedge grouper (Epinephelus flavolimbatus), and snowy grouper (Hyporthodus niveatus). Other dynamics such as multi-species quota discarding are likely responsible for discards of blueline tilefish. Based on the results of the study, potential changes to the GT-IFQ program such as additional flexibility measures were identified as potential management strategies for decreasing discards. A similar approach to inferring why discarding is occurring could be used in the other regions for more effective management promoting long-term sustainability of valuable fisheries.

Donor blood wastage: Reasons & Prevention

Aims: 1 Analysis of various reasons for discard or wastage of donated human blood & 2) Discussion on possible preventive measures for minimization of this loss Materials & Methods: This retrospective study was conducted at the blood bank, department of pathology, GMERS medical college & hospital, Junagadh (Gujarat-India) and included data from records of previous 26 months (January 2017 to February 2019). Reasons for wastage were categorized into four groups namely expiry, under-collection, sero-positivity for TTI & others including leakage, contamination, hemolysis, etc. Results: Total 16,057 blood units were collected and out of them, 240 units (1.49%) were discarded. Out of discarded units, 13.33% were due to Expiry, 37.09% were due to Under-collection, 42.08% were due to Seropositivity and 7.50% were due to other reasons. Conclusion: It is almost impossible to achieve 0% wastage of donated blood. So, appropriate preventive measures must be taken in order to minimize the same.

Procurement Biopsies in the Evaluation of Deceased Donor Kidneys.

Biopsies taken at deceased donor kidney procurement continue to be cited as a leading reason for discard; however, the reproducibility and prognostic capability of these biopsies are controversial. We compiled a retrospective, single-institution, continuous cohort of deceased donor kidney transplants performed from 2006 to 2009. Procurement biopsy information-percentage of glomerulosclerosis, interstitial fibrosis/tubular atrophy, and vascular disease-was obtained from the national transplant database. Using univariable, multivariable, and time-to-event analyses for death-censored graft survival, we compared procurement frozen section biopsy reports with reperfusion paraffin-embedded biopsies read by trained kidney pathologists (n=270). We also examined agreement for sequential procurement biopsies performed on the same kidney (n=116 kidneys). For kidneys on which more than one procurement biopsy was performed (n=116), category agreement was found in only 64% of cases (κ=0.14). For all kidneys (n=270), correlation between procurement and reperfusion biopsies was poor: overall, biopsies were classified into the same category (optimal versus suboptimal) in only 64% of cases (κ=0.25). This discrepancy was most pronounced when categorizing percentage of glomerulosclerosis, which had 63% agreement (κ=0.15). Interstitial fibrosis/tubular atrophy and vascular disease had agreement rates of 82% (κ=0.13) and 80% (κ=0.15), respectively. Ninety-eight (36%) recipients died, and 56 (21%) allografts failed by the end of follow-up. Reperfusion biopsies were more prognostic than procurement biopsies (hazard ratio for graft failure, 2.02; 95% confidence interval, 1.09 to 3.74 versus hazard ratio for graft failure, 1.30; 95% confidence interval, 0.61 to 2.76), with procurement biopsies not significantly associated with graft failure. We found that procurement biopsies are poorly reproducible, do not correlate well with paraffin-embedded reperfusion biopsies, and are not significantly associated with transplant outcomes.

A Retrospective study of analysis of reasons for discard of blood and blood components

Introduction: Blood transfusion is an essential element in modern health care. Transfusion of blood and blood components has become an integral part of patient management in modern medicine. Human blood till date has no substitute. Demand of blood and its components always outpace its supply.This emphasizes the need for proper utilization of blood and its components with preferably “NO” or minimal wastage. Materials and methods: A Retrospective study of analysis was carried out at Sri Siddhartha Medical College Hospital Blood bank from 1st January 2017 to December 31st 2017. Results: Out of 1806 whole blood bags, 371 (5.21%) were discarded. 137(36.9%) units were discarded because of transfusion transmitted infections (TTIs). Out of 11809 components prepared, 1027(8.6%) blood components blood were discarded. Most common component discarded was platelet (40.7%) and reason for discard was date of expiry due to non-utilization. Conclusion:Blood being irreplaceable source, discard rate can be reduced by proper counseling of blood donors and adhering to strict donor deferral criteria.Discard rate of platelet concentrate can be minimized by preparing platelet concentrate on request and also by using modern technique like Apheresis.

Donor blood wastage: a study from blood bank Chamba (H.P)

Background: Blood and its components are very important for human life as there is no substitute for human blood. No major surgical procedure can be performed without the use of blood in any hospital or clinic. Ideally in a good set up, wastage of blood and blood products should never occur. The aim of this study was to assess the burden of blood wastage in our blood bank, reasons for the wastage, and to cut down blood wastage to a minimal amount by adopting new methods and techniques.Methods: A retrospective study was carried out in Department of Blood Bank of Pt. Jawaharlal Nehru Govt. Medical College, Chamba (H.P) over a time period of one year from 1st January 2017 to 31st December 2017.Results: In our study period, there were 35 discarded blood units due to various reasons forming 3.52% of total discard. Majority of units were discarded due to expiry (51.4%).Conclusions: Our study found expiry/outdated units to be most common reason for discard (51.4%). This kind of wastage may be reduced by better management of blood bag collection, storage and utilization. TTI was another significant reason for blood discard in our blood bank (14.28%). We can bring down the number of discard units by proper training and educating our blood bank staff. Strict adherence to donor selection criteria and proper past medical history should be obtained from blood donors.

Factors leading to the discard of deceased donor kidneys in the United States

The proportion of deceased donor kidneys procured for transplant but subsequently discarded has been growing steadily in the United States, but factors contributing to the rising discard rate remain unclear. To assess the reasons for and probability of organ discard we assembled a cohort of 212,305 deceased donor kidneys recovered for transplant from 2000-2015 in the SRTR registry that included 36,700 kidneys that were discarded. 'Biopsy Findings' (38.2%) was the most commonly reported reason for discard. The median Kidney Donor Risk Index of discarded kidneys was significantly higher than transplanted organs (1.78 vs 1.12), but a large overlap in the quality of discarded and transplanted kidneys was observed. Kidneys of donors who were older, female, Black, obese, diabetic, hypertensive or HCV-positive experienced a significantly increased odds of discard. Kidneys from donors with multiple unfavorable characteristics were more likely to be discarded, whereas unilaterally discarded kidneys had the most desirable donor characteristics and the recipients of their partner kidneys experienced a one-year death-censored graft survival rate over 90%. There was considerable geographic variation in the odds of discard across the United States, which further supports the notion that factors beyond organ quality contributed to kidney discard. Thus, while the discard of a small fraction of organs procured from donors may be inevitable, the discard of potentially transplantable kidneys needs to be avoided. This will require a better understanding of the factors contributing to organ discard in order to remove the disincentives to utilize less-than-ideal organs for transplantation.

Region specific analysis for the use of ‘universal’ donor group O D− red blood cell units within Australia

ObjectivesIn Australia, the demand for group O D− red blood cell (RBC) units is proportionally increasing in contrast with an overall reduction in RBC demand. A survey was conducted to understand the use of group O D− RBC units. Aggregated national data from this study have been reported. However, Australia has large geographical and jurisdictional differences in blood product funding arrangements, transfusion and inventory management practices. This region specific analysis was conducted to understand these differences in the use of group O D− RBC units.DesignThe fate of each O D− RBC unit issued during a 5‐week period (n = 9733) was analysed including urgency of transfusion, product age, patient demographics or reason for discard. The data were divided to represent five regions representing 1‐2 states and/or territories across Australia.ResultsRegions 1 and 5 had the lowest number of O D− RBC units issued per 1000 population. Region 4 had the lowest percentage of discard (3·8%) compared with the national average of 7·9%. Region 4 also had the lowest percentage (44·0%) of O D− RBC units transfused into nongroup O D‐ recipients compared with the national average of 52·2%.ConclusionsThe differences in usage of group O D− RBC units among regions were not statistically significant. However, possible region specific practices, such as the presence of a well‐developed blood rotation programme, could impact O D− RBC demand. Shared learning across all regions could assist in ameliorating the increasing national O D− RBC demand in Australia.

Reasons for Discarding of Whole Blood/Red Cell Units in a Regional Blood Transfusion Centre in Western India.

To analyze the reason for discarding whole blood and red cell concentrates in a Regional Blood Transfusion Centre in India. Retrospective analysis of electronic data on collection of blood and reason for discard of whole blood and red cell concentrate between January 2012 and December 2016. 1,70,431 units of blood were collected between January 2012 and December 2016 in various blood donation camps. On an average 6.60% whole blood or red cell units were discarded because of various reasons. Out dating was the single important cause for discarding such units leading to loss of 6.7-7 million rupees (USD 1,00,000) to the blood bank. Infective units, haemolysed units, insufficient amount collected units and leakage were other important causes for discarding the units. Using multiple approaches of donor selection, staff training rescheduling of blood camps and sharing this precious resource with other blood bank can significantly minimize the discard rate. The reasons for discard of blood units varied not only from one blood centre to other but also from one country to another.

Parameters involved in the internal reverse logistics of a hospital pharmacy

This research aims to identify the causes linked to internal reverse logistics of materials and medicines in a hospital, covering studies for process optimization performed by this department. The study is based on a hospital located in the State of Paraná, Brazil. First, observations were performed through visits during the months of September/2015 to April/2016, and the month of March was chosen for the collection of data. Also, "in loco" visits were carried out for better understanding the process that occurs in both of the drug shipment to patients, as the internal reverse logistics was performed with drugs. To collect the data a survey form was used on the main reasons for discarding of drugs and materials for the central pharmacy. The instrument was adapted from the form used by the institution aimed specifically to the Intensive Care Unit. Through the observations made in the Hospital Unit, it was revealed that the company has a structured logistics process, standardized, and has a fundamental tool for this: information technology, creating efficient, reliable and fast data, requiring however, some improvements aiming primarily to prevent and reduce waste of both time and materials/medicines.

A Re-evaluation of Discarded Deceased Donor Kidneys in the UK: Are Usable Organs Still Being Discarded?

A significant proportion of procured deceased donor kidneys are subsequently discarded. The UK Kidney Fast-Track Scheme (KFTS) was introduced in 2012, enabling kidneys at risk of discard to be simultaneously offered to participating centers. We undertook an analysis of discarded kidneys to determine if unnecessary organ discard was still occurring since the KFTS was introduced. Between April and June 2015, senior surgeons independently inspected 31 consecutive discarded kidneys from throughout the United Kingdom. All kidneys were biopsied. Organs were categorized as usable, possibly usable pending histology, or not usable for implantation. After histology reports were available, final assessments of usability were made. There were 19 donors (6 donations after brain death, 13 donations after circulatory death), with a median (range) donor age of 67 (29-83) years and Kidney Donor Profile Index of 93 (19-100). Reasons for discard were variable. Only 3 discarded kidneys had not entered the KFTS. After initial assessment postdiscard, 11 kidneys were assessed as usable, with 9 kidneys thought to be possibly usable. Consideration of histological data reduced the number of kidneys thought usable to 10 (10/31; 32%). The KFTS scheme is successfully identifying organs at high risk of discard, though potentially transplantable organs are still being discarded. Analyses of discarded organs are essential to identify barriers to organ utilization and develop strategies to reduce unnecessary discard.

An analytical study of discarded units of whole blood in blood bank of KIMS Hubballi, a tertiary care hospital of North Karnataka

Objective: Blood is a vital fluid for the body which should be properly stored and utilized so that it can be used in emergencies. This study has been done to determine the number of units of whole blood discarded in blood bank of Karnataka Institute of Medical Sciences, Hubli, the various reasons of discards and the methods for reducing this wastage. Methods: The study was conducted for the period of 9 years from January 2007 to December 2015 wherein the number of collected blood units, blood units discarded and reasons for discard of these blood units in this period, was analysed. Discarded blood unit with respect to the blood group was also studied for last six years i.e. from January 2010 to December 2015. Results: The total blood storage units for the period of 9 years were 80,312 units, of which, 4,685 bags were discarded. There were various reasons found behind this wastage. The main reason being the transfusion transmitted infections which accounted for 2113 units (45.10%). Other reasons being suboptimal collection of blood bags (8.13%), damaged bags (1.66%), expired bags (37.78%). Conclusion: Blood transfusion is an essential part of patient care. It is important to implement proper blood transfusion management policies which will help utilize the blood and it’s components in a more efficient manner with minimal wastage

OPO Strategies to Prevent Unintended Use of Kidneys Exported for High PRA (>98% cPRA) Recipients.

Since the advent of the Kidney Allocation System (KAS), matched candidates with high (>98%) panel reactive antibody (hPRA) are given priority over local candidates with lower PRA. This often leads to exporting of kidneys. Data for these kidneys are not detailed on routine reports. Twenty-two organ procurement organizations prospectively submitted data from August 2015 to July 2016, describing allocation practices of kidneys to hPRA patients and outcomes of these kidneys. Five hundred twenty out of 6924 procured kidneys were exported for hPRA recipients. Of these, 402 (77.3%) were transplanted into the intended recipient (IR); 100 (19.2%) were transplanted into unintended recipients (UR), and 18 (3.5%) were discarded. The most common reason for use in an UR was a positive crossmatch (XM) (63%). The most common reasons for discard were donor quality (44%) and ischemic time (39%). Prior to kidney export, when tissue crossmatching was done, 96.2% of the kidneys went to the IR, versus 80.7% following virtual CM, versus 56.7% when no crossmatching was performed (p < 0.0001). A significant number of kidneys exported for hPRA patients are not being used in the IR or are being discarded. The most common reason for this is positive tissue XM. We report that unintended use of the kidney was minimized when tissue was shipped and XM results were known prior to exporting the kidney.

A national review of the clinical use of group O D- red blood cell units.

There has been an international decline in the demand for red blood cell (RBC) units. In Australia, there has been a 21% reduction in demand between 2012 and 2015. In contrast, the demand for the "universal" group O D- RBC units is in fact proportionally increasing. The clinical use of the entire O D- RBC distribution for a 5-week period throughout Australia was reviewed. Fate data on each unit issued (n = 9733) were collected that included the indication and urgency of transfusion, reason for discard, component age, and patient demographics. A total of 74% of audit forms were returned (n = 7143). The national discard rate of issued units was 7.9%. A total of 6387 units were transfused into an estimated total of 3008 patients (55% males) with median patient age of 67 years and median RBC age of 21 days. Forty-seven percent were transfused to group O D- patients. A total of 17.4% were chosen for specific phenotype requirements, 24.5% of units were transfused close to expiry, and 24.5% were transfused into patients of other ABO groups. The data appear broadly representative of the current transfusion and inventory management practices surrounding the use of group O D- RBC units. Strategies to reduce O D RBC demand include reevaluation of inventory holdings particularly at smaller centers, increasing the panel of phenotyped RBC units across all ABO groups, more regular rotation of units between hospitals to minimize time expiry, and continuing education for promoting transfusion of ABO-identical RBC units.

Analysis on discard of blood and its products with suggested possible strategies to reduce its occurrence in a blood bank of tertiary care hospital in Western India

Background: Blood is precious and should be utilized judiciously with minimal wasting. By analyzing the data and the reasons for discard, the blood transfusion service can develop plans to evaluate causes that lead to discard of blood and its components and interventions that can be used to optimize their use by training and education. Aim: (1) The aim of the study was to evaluate causes that lead to discard of blood and its components and interventions that can be used to optimize their use by training and education, (2) to introduce possible strategies for minimizing blood wastage, and to observe and compare the discard rate after the implementation of strategies. Materials and Methods: The study of analysis on discard of blood and its products was carried out retrospectively from January 2014 to December 2016 (36-month period), and the data were collected from the blood bank database system using Easy Software in the Department of Transfusion Medicine, Shri M P Shah Govt. Medical College, Jamnagar in Western India. The results were analyzed using Microsoft Excel 2007 database sheet, percentage calculated and Chi-square test was applied between different variables with P value set a significant when

A 14-Year Audit and Analysis of Human Skin Allograft Discards.

The objective of this study was to review the incidence of skin allograft discard and bacterial contamination due to donor bioburden at the Ontario Professional Firefighters Skin Bank over a 14-year period. We sought to determine whether modifications to our prerecovery donor preparation process have been effective in reducing skin bioburden and identify other potential risk factors of allograft contamination. A retrospective review of all skin donors (n = 259) processed from 2002 to 2015 was performed. Multivariate logistic regression was used to determine whether donor-related factors and procurement-related factors were significantly associated with microbial contamination predisinfection and discard secondary to contamination. Eighty-one donor recoveries were discarded (81/259; 31%) or 694 grafts (694/2636; 26%), with bacterial contamination being the most common reason for discard (29/81; 36%) followed by positive viral serology (21/81; 26%) primarily for hepatitis B core antibodies. Bacterial contamination predisinfection was detected in 46% of donors (49% of grafts). Analysis of risk factors showed that only donor preparation using a 70% alcohol spray significantly reduced odds of both bacterial contamination predisinfection (P < .0001) and discard secondary to bacterial contamination (P = .0233). Our results suggest that selective screening of donors to reduce risk of microbial contamination is unlikely to alter the rate of allograft contamination. However, use of a 70% alcohol spray during donor preparation may minimize bacterial contamination and subsequent bacterial-related discards. Given that detailed guidelines for donor preparation do not exist, use of an alcohol spray may be of value for tissue banks experiencing allograft loss due to bacterial contamination.

Incidence and Causes of Wastage of Blood &amp; Blood Components in a Blood Bank of Tertiary Care Hospital: A Retrospective Study

Abtract Context:There is always a dearth of blood available for transfusion which can be reduced with more efficient utilization of blood or blood components Aims:This study was aimed at finding reasons for discarding blood or blood components and to develop plans to reduce wastage Materials and Methods:This was a retrospective observational study in blood bank unit of tertiary care hospital and included data from records for one year(1 st Jan 2014 to 31 st Dec 2014). Majority of blood donations were subjected to blood components processing. Reason for discarding blood or blood components was observed and results were analysed. Results:Total 11923 blood bags were collected, 11804 were subjected to component preparation. Overall discard rate of whole blood and components was 5.8%. Most common reason for discard was TTI (74.2%), of which HCV formed the majority. Non-utilization due to expiry (17.1%), blood sent for quality control(3.9%) and other causes(leakage, contamination, DCT positivity and no available segment for cross match) constituted 4.8% of the discard rate. Conclusions:Proper utilization of blood is needed with ideally zero percentage wastage. Most common reason for discard of blood/blood products in our study was seropositivity, followed by non-utilization of blood/blood products beyond expiry date. Proper screening of donors, detailed history, issuing blood/components based on FIFO (First in First out) policy and regular audit by hospital transfusion committee will help to reduce wastage.

North Spanish fisheries: discards, causes and reduction measures

North Spanish fisheries: discards, causes and reduction measures

Skin donors and human skin allografts: evaluation of an 11-year practice and discard in a referral tissue bank.

The Saint Louis hospital tissue bank provides skin allografts to pediatric and adult burn units in the Paris area. The aim of this study was to analyze our activity during the last 11 years focusing on the reasons for skin discard. Skin is procured solely from the back of the body, which is divided into 10 zones that are harvested and processed separately. This retrospective study included all skin donors harvested between June 2002 and June 2013, representing a total of 336 donors and 2770 zones. The donors were multiorgan heart-beating donors in 91 % of cases (n = 307). The main reason for discarding harvested skin was microbial contamination, detected in 99 donors (29 %). Most contaminants were of low pathogenicity. Other reasons for discard included positive serologic tests for 2 donors [17 zones (0.61 %)], unsuitable physical skin characteristics for 3 zones (0.11 %), the donor's medical history for 53 zones (1.91 %), and technical issues with processing or distribution for 61 zones (2.2 %). In our experience, microbial contamination continues to be the main reason for discarding potential skin allografts. However, discards are limited by separate harvesting and processing of multiple zones in each donor.

Improving efficiency of a regional stand alone bone bank.

The introduction of a stand-alone Bone Bank in our Regional Orthopaedic Hospital has improved the availability of femoral head allograft. Benninger et al. (Bone Joint J 96-B:1307-1311, 2014), demonstrated their institutions bank to be cost effective despite a 30 % discard rate for harvested allograft. We sought to audit our own discard rates and subsequent cost-effectiveness of our bone bank. Donor recruitment. Before approaching a potential donor, our establishment's nurse specialists review their clinical notes and biochemical laboratory results, available on a regional Electronic Care Records. They view femoral head architecture on radiographs against set criteria, Patient Archive and Communication system (SECTRA, Sweden). In total 1383 femoral heads were harvested, 247 were discarded giving an overall rate of 17.9 %. The most common reasons for discard of harvested graft was a positive microbiology/bacteriology result, n = 96 (38.9 %). After a rise in discard rates in 2007, we have steadily reduced our discard rates since 2006/2007 (28.2 %), 2008/2009 (17 %), 2010/2011 (14.8 %), and finally to 10.3 % in 2012/2013. In the current financial year, our cost to harvest, test, store and release a femoral head is £ 610. With a structured donor recruitment process and unique pre-operative radiographic analysis we have successfully reduced our discard rates bi-annually making our bone bank increasingly cost-effective.

P156 How much antiretroviral therapy do we discard?: Abstract P156 Table 1

Background/introduction Current audit standards for antiretroviral therapy (ART) prescribing do not include standards for quantity dispensed. Aim(s)/objectives 1) Establish a clinical standard for the quantity of ART to dispense when initiating or switching therapy. 2) Make a qualitative assessment of avoidable discards of ART. 3) Audit prescribing against existing BHIVA standards. Methods An HIV care unit’s database was interrogated to identify 350 patients who had initiated or switched ART over 2 years to August 2014. ART prescribing and outcomes data were collected retrospectively from 110 randomly selected patients. Results 58.2% (n = 64) switched therapy; 57.8% (n = 37) as a result of toxicity, 15.6% (n = 10) resulting from rationalisation of therapy and only 3.1% (n = 2) for virological failure. The median quantity of ART dispensed at initiation or switch was 8 weeks (IQR; 8–12) supply; discarded at switch was 1.5 days (IQR; 0–29.75) supply. Mean (SD) cost of discarded ART after switch was £311.11 (£11.54); median was £20.63 (IQR; £0-£334.94). Reasons for discard for patients in the highest cost quartile are displayed in Table 1. Discussion/conclusion Dispensing 8 weeks of ART at initiation or switch results in a lower than expected cost of discarded ART. There is limited potential for reduction in avoidable discards by addressing the small number of high cost cases.