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.
Interest(s): Advanced Practice Professionals, , Brain Death / Death by Neurologic Criteria, Checklists & Forms, Donation after Circulatory Death (DCD), Donor Management, Electronic Medical Records (EMR), Emerging Technology, Ethics, Family Care, Finance, Growth in Transplantation, Histocompatibility / HLA, Hospital Donation Process & Education, HR & Staffing, Innovation, Legal and Regulatory, Marginal / Increased Risk Organs, NASEM Recommendations, Normothermic Regional Perfusion (NRP), Organ Allocation (Offer and Acceptance), Organ Preservation and Perfusion, Organ Transportation / Logistics, Patient Safety, , Quality Assurance and Performance Improvement (QAPI)
Organ(s): Heart, Kidney, Liver, Lung, Pancreas
Patient Group(s): Adult
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Two Years of Centralizing Donation After Cardiopulmonary Death
Geoffrey
Funk
, Southwest Transplant Alliance
The Challenge
The organ procurement center (OPC) model entails transporting organ donors to a centralized location or facility operated by an organ procurement organization (OPO), where workflows, expertise, and resources dedicated to organ donation and allocation are concentrated. For donation after cardiopulmonary death (DCD), OPOs must rely on hospital partners to serve as centralized facilities. This study aims to evaluate the impact of a two-year centralized DCD program on organ outcomes and utilization.
The Approach
This is a descriptive study using data from one OPO. The study includes only authorized DCD donor candidates between 03/06/2023 and 03/05/2025. Chi-square tests were used to assess categorical differences between the transferred and non-transferred groups, and a Student’s t test was performed to examine differences between the number of organs transplanted.
The Results
A total of 783 authorized DCD cases were included in this study, 98 (12.5%) of whom were transferred to a centralized facility. Among those transferred, 60.2% (59/98) went on to become organ donors whereas only 42.8% (293/685) of non-transferred DCD cases became donors (p=.0012). This suggests that a greater proportion of authorized donor candidates who are transferred to a centralized facility become organ donors compared to those who are not transferred.
Expiration
Among the 561 DCD donor candidates that experienced the withdrawal of life-sustaining treatment (WLST), 37.2% (35/94) of transferred candidates did not expire in the allotted timeframe whereas 36.6% (171/467) of those that were not transferred did not expire (p=.9099). This suggests that centralizing DCD recoveries does not affect the likelihood of progressing to circulatory death.
Zero-organ Donors
Out of the 94 that progressed to comfort care and possible donation, 51 (54.2%) donated gifts that were transplanted into a recipient compared to 250 (53.5%) of the 467 donors who were not transferred and progressed to comfort care and possible donation. Therefore,
transfer status has no statistical effect on the ability to allocate organs for transplant. This also indicates that selection bias does not impact transfer status. In other words, the OPO is not merely transferring donor candidates with characteristics most compatible with donation.
Organs Transplanted
Among donors from whom at least one organ was recovered, the average number of organs transplanted per donor was 2.83 among the transferred group and 2.46 among the non-transferred group (p=.0678). While this did not quite achieve statistical significance, there is still practical significance that will only increase with a larger sample size and more experience. Additionally, the transferred group transplanted more organs across all organ types (heart, kidney, liver, and lung), namely lungs (mean difference = 0.18, p=.0467). Table 1 shows a complete list of the averages.
Table 1
Organ Not transferred Transferred Difference Sig.
Lung 0.21 +/- 0.04 0.39 +/- 0.08 0.18 0.0467
Liver 0.40 +/- 0.03 0.51 +/- 0.06 0.11 0.1216
Kidney 1.06 +/- 0.05 1.14 +/- 0.12 0.08 0.5619
Heart 0.18 +/- 0.02 0.20 +/- 0.05 0.02 0.6855
Insights & Lessons Learned
In this study, centralizing DCD recoveries was associated with higher organ donation and utilization rates. Transferred cases were more likely to proceed to organ donation and contributed to a greater number of recovered and transplanted organs per donor compared to non-transferred cases. Notably, the number of transplanted lungs was significantly higher among the transferred population. These findings suggest that centralized facilities may play a role in optimizing organ recovery and utilization, potentially improving overall transplant outcomes.