Case Studies
Case studies showcase real-world applications of policies and innovations, offering insights into improving outcomes and efficiency. They enhance problem-solving skills, highlight best practices, and engage through storytelling for education and transparency.
Individualized, Provider-Directed Donor Management: An ICU-Based Alternative to Traditional DCU Models
Patricia
Raval
, DMSc, PA-C, CCAPP
, Lead APP Donor Mgmt and Support Team
, Perfusion Solution
The Challenge
Traditional Organ Procurement Organization (OPO) donor care unit (DCU) models often rely on protocolized management and remote oversight, which may limit individualized care for medically complex donors. As donor acuity increases and acceptance criteria expand, advanced critical care expertise and real-time physiologic decision-making are increasingly necessary to optimize organ recovery. The Donor Management and Support Team (DMaST) was developed as a provider-led donor management model designed to deliver ICU-level, individualized care while working collaboratively with OPO teams to optimize organ recovery and increase allocation potential.
The Approach
DMaST is a multidisciplinary specialist donor management program staffed by providers with decades of combined experience in ICU, transplant, and donor management. The team is led by board-certified physicians in critical care, with heart failure and transplant cardiology physicians available for consultation. DMaST providers deliver care directly at the donor hospital, eliminating the need for donor transfer to a centralized DCU. Providers manage donors on-site or remotely and perform invasive procedures including arterial line, central venous catheter, and pulmonary artery catheter placement, as well as bedside point-of-care ultrasound (POCUS) and bronchoscopy when indicated. Donor management is individualized based on donor physiology and organ recovery trajectory, with tailored strategies for volume resuscitation, diuresis, vasoactive and inotropic support, hormone replacement, ventilatory management, and pulmonary optimization. Care is guided by invasive hemodynamics, echocardiography, laboratory trends, and organ-specific goals rather than fixed protocols. In addition, structured marginal cardiac and pulmonary recovery pathways were implemented to support reassessment of organs initially considered unsuitable.
The Results
Over a 16-month period, donor cases involving DMaST management in partnership with LifeLink of Florida demonstrated an average of 3.415 organs transplanted per donor (OTPD) across all age groups. Among DMaST-managed donors aged 50 years and younger, the average OTPD was 4.23. Individualized, provider-directed management enabled dynamic adjustment of hemodynamics, volume status, endocrine disturbances, and pulmonary function in response to evolving donor conditions. By managing donors at the originating hospital, this collaborative model avoided interfacility transfer–related logistical challenges and potential physiologic instability, while supporting continuity of care and family-centered decision-making. Compared with traditional protocol-driven DCU management models, this provider-led approach emphasizes real-time clinical decision-making and bedside procedural capability, allowing tailored optimization for donors with greater medical complexity. To date, marginal cardiac recovery pathways supported transplantation of seven hearts initially deemed unsuitable, without the use of ex vivo machine perfusion strategies. Ongoing data collection is assessing organ utilization patterns and post-transplant outcomes.
Insights & Lessons Learned
A provider-led, ICU-based donor management model implemented in collaboration with an OPO offers a differentiated approach compared with traditional OPO DCU structures by enabling real-time, individualized care tailored to each donor’s unique physiology and organ potential. Incorporation of advanced critical care expertise, invasive monitoring, bedside procedures, and subspecialty consultation, in partnership with local OPOs, may support increased organ utilization, particularly in medically complex donors. Further multi-OPO evaluation is warranted to assess scalability, reproducibility, and recipient outcomes.