title: Impact of a quality improvement project on deceased organ donor management.
abstract: BACKGROUND
  Donors showed poor glucose control in the period between declaration of brain death and organ recovery. The level of hyperglycemia in the donors was associated with a decline in terminal renal function.
  
  
  OBJECTIVE
  To determine whether implementation of a quality improvement project improved glucose control and preserved renal function in deceased organ donors.
  
  
  METHODS
  Data collected retrospectively included demographics, medical history, mechanism of death, laboratory values, and data from the United Network for Organ Sharing.
  
  
  RESULTS
  After implementation of the quality improvement project, deceased donors had significantly lower mean glucose concentrations (mean [SD], 162 [44] vs 212 [42] mg/dL; P<.001) and prerecovery glucose concentration (143 [66] vs 241 [69] mg/dL; P<.001). When the donor cohorts from before and after the quality improvement project were analyzed together, mean glucose concentration remained a significant predictor of terminal creatinine level (P<.001). Multivariate analysis of delayed graft function in kidney recipients matched to donors indicated that higher terminal creatinine level was associated with delayed graft function in recipients (P<.001).
  
  
  CONCLUSIONS
  The quality improvement project improved donor glucose homeostasis, and the data confirm that poor glucose homeostasis is associated with worsening terminal renal function.
authors.affiliation: University of California, San Francisco (AO, JF, RH, JPR, CUN), California Transplant Donor Network, Oakland, California (SS), Hospital Clinic, Barcelona, Spain (AB).
authors.forename: Andrea
authors.initials: A
authors.lastname: Olmos
authors.affiliation: University of California, San Francisco (AO, JF, RH, JPR, CUN), California Transplant Donor Network, Oakland, California (SS), Hospital Clinic, Barcelona, Spain (AB).
authors.forename: John
authors.initials: J
authors.lastname: Feiner
authors.affiliation: University of California, San Francisco (AO, JF, RH, JPR, CUN), California Transplant Donor Network, Oakland, California (SS), Hospital Clinic, Barcelona, Spain (AB).
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Hirose
authors.affiliation: University of California, San Francisco (AO, JF, RH, JPR, CUN), California Transplant Donor Network, Oakland, California (SS), Hospital Clinic, Barcelona, Spain (AB).
authors.forename: Sharon
authors.initials: S
authors.lastname: Swain
authors.affiliation: University of California, San Francisco (AO, JF, RH, JPR, CUN), California Transplant Donor Network, Oakland, California (SS), Hospital Clinic, Barcelona, Spain (AB).
authors.forename: Annabel
authors.initials: A
authors.lastname: Blasi
authors.affiliation: University of California, San Francisco (AO, JF, RH, JPR, CUN), California Transplant Donor Network, Oakland, California (SS), Hospital Clinic, Barcelona, Spain (AB).
authors.forename: John P
authors.initials: JP
authors.lastname: Roberts
authors.affiliation: University of California, San Francisco (AO, JF, RH, JPR, CUN), California Transplant Donor Network, Oakland, California (SS), Hospital Clinic, Barcelona, Spain (AB).
authors.forename: Claus U
authors.initials: CU
authors.lastname: Niemann
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001926:Brain Death / Q000503:physiopathology*; D002102:Cadaver; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D019737:Transplants / Q000502:physiology*
chemical_list: D001786:Blood Glucose