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


CONCLUSIONS
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.
Salim
Ali
A
Department of Surgery, Division of Trauma and Critical Care, University of Southern California Keck School of Medicine and the Los Angeles County + University of Southern California Medical Center, Los Angeles, CA 90033, USA. asalim@surgery.usc.edu
Martin
Matthew
M
Brown
Carlos
C
Rhee
Peter
P
Demetriades
Demetrios
D
Belzberg
Howard
H
D000328:Adult; D000704:Analysis of Variance; D001926:Brain Death; D002140:California; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000458:organization & administration / Q000706:statistics & numerical data; D014193:Trauma Centers