Analysis of organ procurement failure at an urban trauma center and the impact of HIV on organ procurement at a regional transplantation center.
A 42-month experience with 100 patients with fatal head injuries was analyzed to identify areas of organ procurement failure. Thirty-six patients were ineligible for organ donation. Reasons for exclusion included advanced age (7), sepsis (16), hepatitis (1), systemic illnesses (3), and HIV infection or risk (9). Resuscitation failure (17 patients) and late deaths from failed support (16 patients) left 31 potential donors. Of the 30 families asked to donate, 17 consented (56.7%). Annual consent rates were 25%, 71%, 75%, and 67%. Efforts to improve organ procurement should focus on resuscitation and physiologic support of potential donors. To assess the impact of HIV infection or risk on organ procurement, a 3-year experience of the regional transplantation center (RTP) was reviewed. Of 1,714 referrals to the RTP from 102 hospitals, 1,120 were from trauma centers. The incidence of rejection because of HIV risk or infection was significantly higher in the trauma center group than in the group from non-trauma centers, 17.2% versus 10.2% (p less than 0.004). A similar difference was noted between metropolitan and suburban hospitals (p less than 0.0001). Hepatitis risk was comparable, 3.9% vs. 3.2%. The risk of HIV infection is emerging as a factor limiting organ donation at urban trauma centers.
Ivatury
R R
RR
Department of Surgery, New York Medical College, Bronx.
Grewal
H
H
Simon
R J
RJ
Saunders
W
W
Stahl
W M
WM
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D006259:Craniocerebral Trauma / Q000150:complications / Q000453:epidemiology*; D015658:HIV Infections / Q000453:epidemiology*; D015497:HIV-1; D006302:Health Services Research; D006505:Hepatitis / Q000150:complications / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007258:Informed Consent / Q000706:statistics & numerical data; D008020:Life Support Care / Q000592:standards; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012151:Resuscitation; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000453:epidemiology; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards* / Q000706:statistics & numerical data; D014193:Trauma Centers; D017211:Treatment Failure