An In Depth Assessment of Unsuccessful DCD Donor Procurement Attempts: Areas for Improvement
Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
Meeting: 2022 American Transplant Congress
Abstract number: 891
Keywords: Donors, marginal, Donors, non-heart-beating, Liver transplantation, Procurement
Topic: Clinical Science » Liver » 59 - Liver: Expanding the Donor Pool* (Liver: MELD Allocation / Donor Issues)
Session Information
Session Name: Liver: Expanding the Donor Pool* (Liver: MELD Allocation / Donor Issues)
Session Type: Poster Abstract
Date: Saturday, June 4, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Halls C & D
*Purpose: DCD donors are a key way to expand allograft supply but an aggressive strategy of pursuing DCD liver allografts is associated with significant number of unsuccessful donor procurements. Understanding the elements in unsuccessful DCD can allow more efficient decisions, and maximize DCD procurements.
*Methods: All DCD liver procurements from 2019-2021 including those that did not yield a liver for transplant were compiled in a prospective database analyzing outcomes. For the unsuccessful procurements, the donor and logistical parameters, ischemia times, and decision-making parameters were assessed including post x-clamp turndowns and stratified by donor age.
*Results: Our DCD protocol parameters are Age <65, BMI <50, WIT <30min after either <80%O2 Sats or <80mmHg SBP
There were n=312 DCD procurements with 151 (48.3%) donor expiring within protocol time and 94 (30.1%) donor that yielded successful transplants. There were n=14 unsuccessful DCD donor procurements intended for a combined Liver/Kidney transplant
The unsuccessful DCD procurement donors had: Mean Donor Age: 41.7 (Range 14-64), Mean Donor BMI 29.6 (Range 17.5-51), Mean MELD Score 22.0 (Range 6-40). Transportation included flights in 50.5% of these unsuccessful attempts, and the Mean Travel Time was 1hr 19 min making them resource intensive.
Of the unsuccessful DCD procurements, 57/218 (26.1%) donors actually expired within the protocol time but were turned down post x-clamp for a specific reason–fat, fibrosis, flush, size, ischemia timing, anatomy (ie calcified vessels, damage), or other.
Of note, in the 94 donors with a successful DCD procurement, the subsequent liver transplant yielded a 1-yr patient survival of 91.8% and an ischemic cholangiopathy rate of 6.3% indicating a successful strategy.
*Conclusions: An aggressive strategy to pursue all DCD liver donors regardless of age or donor hospital location, found half of the donors meeting our center’s DCD expiration time limits. However further post cross-clamp quality assessment of the allograft reduced the success rate to 30%. Further refinement of our intra-op quality assessment may yield more organs in the future.
To cite this abstract in AMA style:
Rosenzweig M, Finotti M, Martinez E, Lee S, Gupta A, Wall A, Bayer J, Fernandez H, Onaca N, Ruiz R, McKenna GJ. An In Depth Assessment of Unsuccessful DCD Donor Procurement Attempts: Areas for Improvement [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/an-in-depth-assessment-of-unsuccessful-dcd-donor-procurement-attempts-areas-for-improvement/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress