How does the methodological clinical evaluation impact organ donation? Experience from 4 Organ Procurement Organizations (OPO)

ABSTRACT

INTRODUCTION: The lack of a clear and reproducible methodology for evaluating potential organ donors, which ensures traceability in the process, can compromise the number of utilized organ donors and the transplantation quality. METHODOLOGY: We developed a reproducible and safe method for the evaluation and validation of Potential Organ Donors (PD) based on 2 principles1) Updated knowledge of absolute contraindications for organ donation and, 2) Decision making supported by 3 questions. The first principle was absolute contraindications. They were categorized into 4 groups A) Serologies, B) Tumors, C) Infections, and D) Biological risk for transmission of infectious diseases and cancer. The second principle was the decision-making questions A) What is the cause of death? B) Are there absolute contraindications to organ donation? and, C) Are there relative contraindications to organ donation? Each PD was subjected to the same methodology. The questions were answered after knowing the PD's clinical file. The PD was valid only if the set of answers adhered to an established matrix respecting different guidelines. The same physician evaluated each PD in all OPO. We applied in 4 different OPO, 3 of them in the State of São Paulo/Brazil and one in the United Arab Emirates, in different periods, including the SARS-COV 2 pandemic. RESULTS: OPO­SCSP, before the methodology (2007) 62 utilized donors, 205 transplants. After the methodology has been started (2008/2009/2010) 117, 154, 186 utilized donors and 348, 533, 487 transplants, respectively. 2) OPO-BTU, before the methodology (2009) 9 utilized donors and 19 transplants. After the methodology has been started (2010/2011/2012) 17, 36, 49 utilized donors and 38, 90, 143 transplants, respectively. 3) OPO-IDPC, before the methodology (2017) 93 utilized donors and 202 transplants. After the methodology has been started (2018/2019/2020) 107, 177, 187 utilized donors and 219, 395, 356 transplants, respectively. 4) UAE OPO, before the methodology (2020) 9 utilized donors and 35 transplants. After the methodology has been started (2021/2022) 39, 55 utilized donors and 147, 203 transplants, respectively. The percentage increase after the beginning of the methodology, considering the last year evaluated 1) OPO-SCSP 195% (Utilized donors) and 137% (Transplants); 2) OPO-BTU 444% (Utilized donors) and 652% (Transplants); C) OPO-IDPC 101% (Utilized Donors) and 76% (Transplants); 4) OPO-EOTC (United Arab Emirates) 511% (Utilized donors) and 480% (Transplants). CONCLUSION: The methodology used demonstrates that it can directly contribute to increasing the percentage of effective donors and transplants. The increase in donors ranged from 101% to 444%. The percentage growth of transplantation ranged from 76% to 652%. Indirectly, an increase the referrals was observed, motivated by frequent contact with OPO members and ICU professionals.