A greater number of transplantable organs are recovered from deceased donors managed at high-volume hospitals, a new study finds.
Hospitals that handled the highest volume of deceased donors were 52% more likely to procure 4 or more organs per donor compared with hospitals that handled the lowest volume of cases, Darren J. Malinoski, MD, of Portland Veterans Affairs Medical Center in Portland, Oregon, and his team reported in the Journal of the American College of Surgeons, published online ahead of print. The national average is 3 transplantable organs per deceased donor, with a goal of 3.75 established by the Donation and Transplantation Community of Practice in 2013, they noted. High donor volume remained a predictor of superior outcome after adjustment for age, ethnicity, donor type, blood type, body mass index, creatinine, and geographic region.
For the study, the investigators examined all deceased donor cases from February 2012 to June 2015 managed by 10 organ procurement organizations across 3 organ sharing regions (covering California, Oregon, Nevada, New Mexico, Texas, and Utah). A total of 4427 deceased donor cases were handled at 384 hospitals. For analysis, the researchers grouped the hospitals into quartiles based on their case volume.
High-volume hospitals managed an average 9 donors annually and recovered 3.3 organs per donor. Low-volume hospitals managed 0.5 donors annually and recovered 2.9 organs per donor. Each quartile managed similar proportions of standard criteria donors, expanded criteria donors, and donations after circulatory determination of death. Hospital conversion rate was not measured. The investigators also were unable to assess the possible influence of hospital complexity and market competition.
“Our findings suggest we can improve the organ shortage and maximize the gift that patients and their families want to make through organ donation by understanding the aspects of high-volume donor hospitals that contribute to improved outcomes,” Dr Malinoski stated in a news release. Identifying best practices at these hospitals would prove valuable. He also suggested the creation of centralized organ recovery centers to manage deceased donors instead of hospitals.
More than 118,000 people in the United States are waiting for an organ transplant as of February 9, 2017, according to the United Network for Organ Sharing.
1. Patel MS, Mohebali J, Sally M, et al. Deceased Organ Donor Management: Does Hospital Volume Matter? J Am Coll Surg. 2017. doi: 10.1016/j.jamcollsurg.2016.12.004 [Epub ahead of print]
2. High-donor-volume Hospitals Recover More Transplantable Organs Per Donor. American College of Surgeons. January 18, 2017.