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

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

Research output: Contribution to journalArticlepeer-review

99 Scopus citations

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 - Injury, Infection and Critical Care
Volume61
Issue number2
DOIs
StatePublished - Aug 2006

Keywords

  • Brain death
  • Donor management
  • Organ donor
  • Transplantation

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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