*Purpose: Recent organ allocation strategies have elevated the complexity of organ shipment, increasing the organ travel time and distance. Despite these changes, logistics, time, and distance affect organ transplant outcome, are not routinely measured or reported. Lack of transparency limits efficiency. An enhanced understanding of the nuances of organ shipment could improve the rates of organ acceptance, reduce cold ischemia time, and improve recipient outcome.

*Methods: Informed by peer reviewed data, transplant physicians, OPOs, donor families, and hospitals, we built the first, comprehensive organ tracking and data capture system which is being implemented nationwide. GPS location, organ, travel time, travel distance, CIT, mode of transport, delays, time spent at nodes were captured. “On time” = arrival within 60 min of planned time. Node = location-based checkpoint between shipment origin and destination (e.g. airport).

*Results: We report on 125 consecutive organ shipments across the United States. Of these, there were 111 kidneys (89%), 6 livers (5%), 2 pancreata (2%), 1 heart (1%), and 5 (4%) were reported as “other.” Eighty (64%) were moved by ground, and the remainder (n=45; 36%) by air. Of those which flew, 31 (69%) took a single flight, whereas 14 (31% flown organs, 11% total shipments) required two flights. The mean total distance traveled for all organs was 756 miles. The mean distance traveled for ground-shipped organs was 284 miles vs 1600 miles for organs moved by air (p<0.01). Mean distance moved for an organ requiring 2 flights was 2764 miles (range: 1282-5284) vs 1074 miles for 1 flight (range: 302-2701 miles; p<0.01). Of 125 shipments, complete delay analysis data were available for 108. Of these, 57 (53%) were “on time.” Seven organs (6%) arrived early, whereas 44 organs were more than an hour late. The mean delay on arrival was >6 hours, and the range in delays was 1-16 hours. Notably, 13 (30%) of 44 delays occurred in air-shipped organs and 31 (70%) in ground shipped organs. Organs stopped at a mean of 3 nodes, with a mean node time of 9 hours. Fifteen organ shipments (12%) had unplanned stops and 8 of these shipments (53%) were delayed. User interviews indicate this technology improved team workflow, OR planning, clinical staffing, and courier coordination.

*Conclusions: There are opportunities to minimize logistical inefficiencies impacting CIT. Organs travel variable distances and stop frequently. No organs were lost during this study. Only 53% of shipped organs were on-time. The decision to move organs by air vs ground was not solely dependent on distance as some organs moved by air traveled short distances. An integrated ecosystem combining logistical, technological, and clinical factors could enable increased acceptance rates, improved recipient outcomes, reduced financial waste, and protect the donor’s gift of life.

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