2013 - ISODP 2013 Congress


Oral Presentation 6 on Deceased Donor Management

13.2 - Meeting donor management goals maximizes organ recovery in children

Presenter: Thomas, Nakagawa, Winston-Salem, United States
Authors: Thomas Nakagawa, Susan Galbraith, Jim Quetschenbach, Ginger DeLario


Meeting donor management goals maximizes organ recovery in children

Thomas Nakagawa1, Susan Galbraith2, Jim Quetschenbach3, Ginger DeLario3

1Anesthesiology, Wake Forest Baptist Health, Winston-Salem, NC, United States, 2LifeShare of the Carolinas, Charlotte, NC, United States, 3Carolina Donor Services, Durham, NC, United States

 

Introduction

There is a clear need to reduce the gap between donors and patients awaiting transplant. 

Achieving donor management goals (DMGs) results in more organs transplanted per donor (OTPD) in adults.  We sought to determine if meeting DMGs in pediatric donors resulted in more OTPD in addition to other factors that might influence organ recovery and transplantation. 

Methods

Data from 2 Organ Procurement Organizations (OPO) were retrospectively reviewed from 2007 through 2012 for pediatric donors age 0 – 18 years meeting brain death criteria. The time period corresponds with implementation of electronic medical record systems within each organization.  DMGs included: systolic blood pressure appropriate for age, central venous pressure 4-12 cm H2O, arterial pH 7.3-7.5, PaO2> 80 mm Hg on FiO2 ≤ .4, serum Na+ ≤160 meq/L, serum glucose < 200 mg/dL, single vasopressor agent at low dose, and urine output 0.5-7 cc/kg/hour in the 4 hours prior to recovery.  We reviewed number of organs recovered, transplanted, discarded and organs used for research.

Results

148 brain dead pediatric donors had 673 organs recovered for transplantation.  605 organs were transplanted (4.09 OTPD).  102 donors had 4.39 OTPD when > 80% of the DMGs were achieved.  46 donors had 3.37 OTPD when < 80% of the DMGs were met.  24 organs were discarded and 42 organs were used for research.  Surgical damage or damage to organs due to traumatic cause of death occurred in 2 cases. Medical examiner restriction (thoracic organs only) occurred in 4 cases resulting in 8 organs not recovered for transplant.  Discarded organs occurred more frequently in donors < 1 year of age despite exhausting match runs and, in most cases, were pancreata.  The youngest brain dead donor was 9 days old (2 organs recovered).  A total of 29 donors were < 1 year of age.

Conclusions

Meeting > 80% of DMG’s before organ recovery in children resulted in more OTPD.  Other factors influencing organ recovery and organ transplanted included donor age and medical examiner restriction.  


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