title: Optimization of donor management goals yields increased organ use.
abstract: Multiple strategies have been used in an effort to increase the pool of organs for transplantation. Standardizing donor management has produced promising results. Donor management goals (DMGs) are now being used as end points of intensive care unit care during the prerecovery phase but no prospective results have been reported. Data from the United Network for Organ Sharing Region 11 were collected for successful achievement of eight common donor management goals (mean airway pressure [MAP], central venous pressure [CVP], pH, PaO2, sodium, glucose, single pressor use, and urine output) before organ recovery. Two time periods were studied with different panels of DMGs. The analysis identified the success rate of transplantation. Goals were stratified by their statistical correlation with the number of organs transplanted per donor (OTPD) in an effort to identify the most important parameter(s). Eight hundred five organ donors were studied with 2685 organs transplanted. DMGs were assessed through two phases of the study. Achieving DMGs rose from 18 to 66 per cent associated with significant improvement in OTPD (range, 2.96 to 3.45). The success of transplantation was primarily associated with limitations in vasopressor use and PaO2. Tight glucose control did affect the rate of pancreatic transplants. Thoracic organs were the most sensitive to DMGs with a 10- to 15-fold increase in lung transplantation when PaO2 rose above 100 mmHg. MAP, CVP, pH, sodium, and urine output had little effect on transplantation. Standardization of end points of donor management was associated with increased rates of transplantation. Surprisingly, not all standard goals are necessary for optimal organ use. The most significant parameters were the low use of vasopressor agents and oxygenation. Donor management strategies should strive to optimize these goals.
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Kentucky 40202, USA. glen.franklin@louisville.edu
authors.forename: Glen A
authors.initials: GA
authors.lastname: Franklin
authors.forename: Ariel P
authors.initials: AP
authors.lastname: Santos
authors.forename: Jason W
authors.initials: JW
authors.lastname: Smith
authors.forename: Susan
authors.initials: S
authors.lastname: Galbraith
authors.forename: Brian G
authors.initials: BG
authors.lastname: Harbrecht
authors.forename: R Neal
authors.initials: RN
authors.lastname: Garrison
mesh_terms: D002985:Clinical Protocols; D003422:Critical Care; D006801:Humans; D016040:Lung Transplantation / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D016377:Organ Transplantation / Q000592:standards / Q000706:statistics & numerical data*; D009937:Organizational Objectives; D015144:Southeastern United States; D014019:Tissue Donors / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000458:organization & administration*