Performance improvement at our organ procurement organization (OPO) includes retrospective analysis of the triage process for newly referred patients to identify missed opportunities for donation after circulatory death (DCD). Records for a total of 727 patients referred during the 20 months from 1/1/13 to 8/31/14 and without brain dead declaration were reviewed. During this same period an additional 371 brain dead and 22 DCD deceased donor procurements occurred. 490 of the records were eliminated because of bureaucratic issues, cardiac arrest on the ventilator, medical unsuitability, or donor size < 10 kg (N = 6). The remaining 237 records were analyzed to identify key factors associated with either a specific potential for kidney, lung or liver DCD recovery, or failure to obtain consent for donation .

We have identified multiple areas upon which to focus in our effort to increase the DCD rate at our OPO. Identification of a transplant center/surgeon willing to accept kidneys from DCD donors < 10 kg and new implementation of a DCD policy where it was lacking are expected to obviate relevant future lost opportunities. Attention to improving internal OPO functions such as hand-off transfers and follow-through for incoming hospital communications is important to avoid preventable missed donations. External issues at hospitals such as late referrals, and untrained introduction of the organ donation subject appear to be the single largest category of challenges. Accordingly, our educational efforts are being concentrated on them.

Overall, it is clear that significant potential to increase DCD exists within our OPO. Preventable causes of lost opportunities include both internal and external issues that are expected to respond favorably to intensive corrective efforts that have are underway. We have reason to expect an increase in our rate of DCD procurements.

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