title: The impact of meeting donor management goals on the number of organs transplanted per expanded criteria donor: a prospective study from the UNOS Region 5 Donor Management Goals Workgroup.
abstract: OBJECTIVE
  The shortage of organs available for transplant has led to the use of expanded criteria donors (ECDs) to extend the donor pool. These donors are older and have more comorbidities and efforts to optimize the quality of their organs are needed.
  
  
  OBJECTIVE
  To determine the impact of meeting a standardized set of critical care end points, or donor management goals (DMGs), on the number of organs transplanted per donor in ECDs.
  
  
  METHODS
  Prospective interventional study from February 2010 to July 2013 of all ECDs managed by the 8 organ procurement organizations in the southwestern United States (United Network for Organ Sharing Region 5).
  
  
  METHODS
  Implementation of 9 DMGs as a checklist to guide the management of every ECD. The DMGs represented normal cardiovascular, pulmonary, renal, and endocrine end points. Meeting the DMG bundle was defined a priori as achieving any 7 of the 9 end points and was recorded at the time of referral to the organ procurement organization, at the time of authorization for donation, 12 to 18 hours later, and prior to organ recovery.
  
  
  METHODS
  The primary outcome measure was 3 or more organs transplanted per donor and binary logistic regression was used to identify independent predictors with P < .05.
  
  
  RESULTS
  There were 671 ECDs with a mean (SD) number of 2.1 (1.3) organs transplanted per donor. Ten percent of the ECDs had met the DMG bundle at referral, 15% at the time of authorization, 33% at 12 to 18 hours, and 45% prior to recovery. Forty-three percent had 3 or more organs transplanted per donor. Independent predictors of 3 or more organs transplanted per donor were older age (odds ratio [OR] = 0.95 per year [95% CI, 0.93-0.97]), increased creatinine level (OR = 0.73 per mg/dL [95% CI, 0.63-0.85]), DMGs met prior to organ recovery (OR = 1.90 [95% CI, 1.35-2.68]), and a change in the number of DMGs achieved from referral to organ recovery (OR = 1.11 per additional DMG [95% CI, 1.00-1.23]).
  
  
  CONCLUSIONS
  Meeting DMGs prior to organ recovery with ECDs is associated with achieving 3 or more organs transplanted per donor. An increase in the number of critical care end points achieved throughout the care of a potential donor by both donor hospital and organ procurement organization is also associated with an increase in organ yield.
authors: Department of Surgery, Massachusetts General Hospital, Boston.
authors: Madhukar S
authors: MS
authors: Patel
authors: Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, Oregon3Department of Surgery, Oregon Health and Science University, Portland.
authors: John
authors: J
authors: Zatarain
authors: Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, Oregon3Department of Surgery, Oregon Health and Science University, Portland.
authors: Salvador
authors: S
authors: De La Cruz
authors: Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, Oregon3Department of Surgery, Oregon Health and Science University, Portland.
authors: Mitchell B
authors: MB
authors: Sally
authors: School of Medicine, University of California, Davis, Sacramento.
authors: Tyler
authors: T
authors: Ewing
authors: Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, Oregon.
authors: Megan
authors: M
authors: Crutchfield
authors: Department of Surgery, Oregon Health and Science University, Portland.
authors: C Kristian
authors: CK
authors: Enestvedt
authors: Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, Oregon3Department of Surgery, Oregon Health and Science University, Portland.
authors: Darren J
authors: DJ
authors: Malinoski
mesh_terms: D000368:Aged; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009937:Organizational Objectives; D011446:Prospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States