The effect of a protocol of aggressive donor management: Implications for the national organ donor shortage

Ali Salim, Matthew Martin, Carlos Brown, Peter M Rhee, Demetrios Demetriades, Howard Belzberg

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

BACKGROUND: The disparity between the number of people awaiting organ transplantation and the number of organs available has become a public health crisis. As many as 25% of potential donors are lost as a result of cardiovascular collapse (CVC) before organ harvest. A policy of aggressive donor management (ADM) may decrease the number of cadaveric donors lost as a result of CVC. METHODS: Retrospective analysis of potential brain-dead donors evaluated from January 1995 to December 2003 at nine American College of Surgeons-verified Level I trauma centers covered by a regional organ procurement agency. One center (Los Angeles County + University of Southern California Medical Center [LAC]) had an ADM protocol in place instituted January 1999; the remaining eight centers with no ADM protocol were grouped as Center A. The incidence of CVC and organ donation demographics were compared between centers and within LAC before (LAC-Pre) and after (LAC-Post) adoption of ADM. ADM consists of early identification of potential organ donors, a dedicated team that provides medical management, and aggressive fluid resuscitation as well as hormone replacement therapy with solumedrol and thyroxin. RESULTS: The incidence of CVC was significantly higher in LAC-Pre (odds ratio [OR] 15.0, p < 0.001) and Center A (OR 5.8, p < 0.001) compared with LAC-Post. The number of organs harvested per potential donor for LAC-Post (2.4) was significantly higher than LAC-Pre (2.0, p = 0.02) and Center A (2.1, p < 0.01). CONCLUSION: An aggressive donor management protocol decreases the number of donors lost as a result of cardiovascular collapse and increases the number of harvested organs per potential donor.

Original languageEnglish (US)
Pages (from-to)429-432
Number of pages4
JournalJournal of Trauma
Volume61
Issue number2
DOIs
StatePublished - Aug 2006
Externally publishedYes

Fingerprint

Tissue Donors
Tissue and Organ Procurement
Methylprednisolone Hemisuccinate
Odds Ratio
Brain Death
Los Angeles
Trauma Centers
Incidence
Hormone Replacement Therapy
Organ Transplantation
Thyroxine
Resuscitation
Public Health
Demography

Keywords

  • Brain death
  • Donor management
  • Organ donor
  • Transplantation

ASJC Scopus subject areas

  • Surgery

Cite this

The effect of a protocol of aggressive donor management : Implications for the national organ donor shortage. / Salim, Ali; Martin, Matthew; Brown, Carlos; Rhee, Peter M; Demetriades, Demetrios; Belzberg, Howard.

In: Journal of Trauma, Vol. 61, No. 2, 08.2006, p. 429-432.

Research output: Contribution to journalArticle

Salim, Ali ; Martin, Matthew ; Brown, Carlos ; Rhee, Peter M ; Demetriades, Demetrios ; Belzberg, Howard. / The effect of a protocol of aggressive donor management : Implications for the national organ donor shortage. In: Journal of Trauma. 2006 ; Vol. 61, No. 2. pp. 429-432.
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abstract = "BACKGROUND: The disparity between the number of people awaiting organ transplantation and the number of organs available has become a public health crisis. As many as 25{\%} of potential donors are lost as a result of cardiovascular collapse (CVC) before organ harvest. A policy of aggressive donor management (ADM) may decrease the number of cadaveric donors lost as a result of CVC. METHODS: Retrospective analysis of potential brain-dead donors evaluated from January 1995 to December 2003 at nine American College of Surgeons-verified Level I trauma centers covered by a regional organ procurement agency. One center (Los Angeles County + University of Southern California Medical Center [LAC]) had an ADM protocol in place instituted January 1999; the remaining eight centers with no ADM protocol were grouped as Center A. The incidence of CVC and organ donation demographics were compared between centers and within LAC before (LAC-Pre) and after (LAC-Post) adoption of ADM. ADM consists of early identification of potential organ donors, a dedicated team that provides medical management, and aggressive fluid resuscitation as well as hormone replacement therapy with solumedrol and thyroxin. RESULTS: The incidence of CVC was significantly higher in LAC-Pre (odds ratio [OR] 15.0, p < 0.001) and Center A (OR 5.8, p < 0.001) compared with LAC-Post. The number of organs harvested per potential donor for LAC-Post (2.4) was significantly higher than LAC-Pre (2.0, p = 0.02) and Center A (2.1, p < 0.01). CONCLUSION: An aggressive donor management protocol decreases the number of donors lost as a result of cardiovascular collapse and increases the number of harvested organs per potential donor.",
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