title: Incidence and distribution of transplantable organs from donors after circulatory determination of death in U.S. intensive care units.
abstract: BACKGROUND
  All U.S. acute care hospitals must maintain protocols for recovering organs from donors after circulatory determination of death (DCDD), but the numbers, types, and whereabouts of available organs are unknown.
  
  
  OBJECTIVE
  To assess the maximal potential supply and distribution of DCDD organs in U.S. intensive care units.
  
  
  METHODS
  We conducted a population-based cohort study among a randomly selected sample of 50 acute care hospitals in the highest-volume donor service area in the United States. We identified all potentially eligible donors dying within 90 minutes of the withdrawal of life-sustaining therapy from July 1, 2008 to June 30, 2009.
  
  
  RESULTS
  Using prespecified criteria, potential donors were categorized as optimal, suboptimal, or ineligible to donate their lungs, kidneys, pancreas, or liver. If only optimal DCDD organs were used, the deceased donor supplies of these organs could increase by up to 22.7, 8.9, 7.4, and 3.3%, respectively. If optimal and suboptimal DCDD organs were used, the corresponding supply increases could be up to 50.0, 19.7, 18.5, and 10.9%. Three-quarters of DCDD organs could be recovered from the 17.2% of hospitals with the highest annual donor volumes-typically those with trauma centers and more than 20 intensive care unit beds.
  
  
  CONCLUSIONS
  Universal identification and referral of DCDD could increase the supply of transplantable lungs by up to one-half, and would not increase any other organ supply by more than one-fifth. The marked clustering of DCDD among a small number of identifiable hospitals could guide targeted interventions to improve DCDD identification, referral, and management.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, 723 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA. shalpern@exchange.upenn.edu
authors.forename: Scott D
authors.initials: SD
authors.lastname: Halpern
authors.forename: Richard D
authors.initials: RD
authors.lastname: Hasz
authors.forename: Peter L
authors.initials: PL
authors.lastname: Abt
mesh_terms: D000328:Adult; D000367:Age Factors; D001926:Brain Death / Q000175:diagnosis*; D002423:Cause of Death; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D016377:Organ Transplantation; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D014022:Tissue Survival; D014481:United States