title: Impact of compliance with the American College of Surgeons trauma center verification requirements on organ donation-related outcomes.
abstract: BACKGROUND
  In order to maximize organ donation opportunities, the American College of Surgeons (ACS) requires verified trauma centers to have a relationship with an organ procurement organization (OPO), a policy for notification of the OPO, a process to review organ donation rates, and a protocol for declaring neurologic death. We hypothesized that meeting the ACS requirements will be associated with improved donation outcomes.
  
  
  METHODS
  Twenty-four ACS-verified Level I and Level II trauma centers were surveyed for the following registry data points from 2004 to 2008: admissions, ICU admissions, patients with a head Abbreviated Injury Score ≥ 5, deaths, and organ donors. Centers were also queried for the presence of the ACS requirements as well as other process measures and characteristics. The main outcomes measure was the number of organ donors per center normalized for patient volume and injury severity. The relationship between center characteristics and outcomes was determined.
  
  
  RESULTS
  Twenty-one centers (88%) completed the survey and referred 2,626 trauma patients to the OPO during the study period, 1,008 were eligible to donate, and 699 became organ donors. Compliance with the 4 ACS requirements was not associated with increased organ donation outcomes. However, having catastrophic brain injury guidelines (CBIGs) and the presence of a trauma surgeon on a donor council were associated with significantly more organ donors per 1,000 trauma admissions (6.3 vs 4.2 and 6.0 vs 4.2, respectively, p < 0.05).
  
  
  CONCLUSIONS
  Although the ACS trauma center organ donation-related requirements were not associated with improved organ donor outcomes, involvement of trauma surgeons on donor councils and CBIGs were and should be encouraged. Additionally, incorporation of quantitative organ donation measures into the verification process should be considered.
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. darren.malinoski@cshs.org
authors.forename: Darren J
authors.initials: DJ
authors.lastname: Malinoski
authors.forename: Madhukar S
authors.initials: MS
authors.lastname: Patel
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lush
authors.forename: M Lynn
authors.initials: ML
authors.lastname: Willis
authors.forename: Sonia
authors.initials: S
authors.lastname: Navarro
authors.forename: Danielle
authors.initials: D
authors.lastname: Schulman
authors.forename: Tasha
authors.initials: T
authors.lastname: Querantes
authors.forename: Ramona
authors.initials: R
authors.lastname: Leinen-Duren
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
mesh_terms: D001930:Brain Injuries / Q000401:mortality; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D015141:Los Angeles; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D012955:Societies, Medical / Q000592:standards; D009927:Tissue and Organ Procurement / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality