RESUMEN
BACKGROUND: Existing methods of comparing organ procurement organization (OPO) performance use administrative data to indirectly measure donation after circulatory death (DCD). The purpose of this study was to categorize and quantify reasons that potential DCD donors do not progress to donation to facilitate the direct measurement of OPO donor potential. METHODS: Records of all 18 685 potential organ donors referred to the organ procurement agency OneLegacy in 2021 and 2022 were reviewed, and reasons that cases did not proceed to donation were categorized and quantified. All hospital deaths were reviewed through tissue referrals and chart audits to assess whether potential organ donors were not referred. RESULTS: There were 8349 potential DCD donors. Of these, 5640 cases were ruled out for clinical reasons, and 1458 cases were ruled out for factors unique to DCD, such as ventilation, which was never withdrawn. Of the 1251 ruled in for the family approach to donation consent, there were ultimately 191 donors with organs transplanted. CONCLUSIONS: OPO donor potential calculated from referral and hospital death record reviews is substantially lower than donor potential determined by administrative data, validating the need for direct measurement for regulatory purposes and performance improvement. For a usable direct measure of donor potential, DCD donor criteria must be codified, electronic donor records optimized, and audit processes developed.
RESUMEN
A large number of procured kidneys continue not to be transplanted, while the waiting list remains high. Methods: We analyzed donor characteristics for unutilized kidneys in our large organ procurement organization (OPO) service area in a single year to determine the reasonableness of their nonuse and to identify how we might increase the transplant rate of these kidneys. Five experienced local transplant physicians independently reviewed unutilized kidneys to identify which kidneys they would consider transplanting in the future. Biopsy results, donor age, kidney donor profile index, positive serologies, diabetes, and hypertension were risk factors for nonuse. Results: Two-thirds of nonused kidneys had biopsies with high degree of glomerulosclerosis and interstitial fibrosis. Reviewers identified 33 kidneys as potentially transplantable (12%). Conclusions: Reducing the rate of unutilized kidneys in this OPO service area will be achieved by setting acceptable expanded donor characteristics, identifying suitable well-informed recipients, defining acceptable outcomes, and systematically evaluating the results of these transplants. Because the improvement opportunity will vary by region, to achieve a significant impact on improving the national nonuse rate, it would be useful for all OPOs, in collaboration with their transplant centers, to conduct a similar analysis.
