Organ recovery professionals and donor hospitals are under intense pressure to go to whatever lengths necessary to provide transplantable organs. However, such a mentality can potentially result in serious inefficiency as when resources are expended on recovering organs from a donor that goes through an operation, but no transplant results. Not only are such cases wasteful of resources, but they can erode enthusiasm for donation and can profoundly disappoint donor families.

Methods: We reviewed all donor cases in our organ procurement organization (OPO) from 2012 through 2014 where organs were removed with the intention of transplantation, but no transplant occurred. Unsuccessful donation after cardiac death (DCD) cases in which cardiac arrest did not ensue in a timely fashion were not included. Demographics, chronic health history, kidney pump parameters, biopsy results, as well as reasons that transplantation did not occur were collected and analyzed.

Results: In the study period, 58 cases were identified which met inclusion criteria. This represented 7% of the 798 donors at the OPO during the same period where organs were successfully transplanted. 67% of such donors were DCD. Mean age was 48 yrs, 53% were male, 47% female. Only 21% were 60 yrs of age or older and only 3 donors were one yr of age or younger, implying that extremes of age did not appear to be a significant contributor to zero organs being used. Major reasons why kidneys were ruled out for transplant were a result of poor biopsy findings or pumping parameters 84% of the time. Anatomic abnormalities contributed in 16% of cases, surgical errors contributed in 7% of cases and infectious concerns due to positive serology, behavioral risk factors, or malignancy contributed in 7% of cases in which zero organs were used for transplantation. In instances where liver recovery was planned but did not occur, the majority reasons were fatty appearance or biopsy (58%), followed by fibrosis or cirrhosis (33%). No covariate could be identified that appeared to predict non-recovery.

Conclusions: Zero organ transplant cases may be a fact of life for organ recovery programs as the majority of the reasons organs were not transplanted cannot be known without laparotomy. However, imaging and especially biopsy to evaluate for donor disease prior to organ recovery, especially for the liver, may obviate a sizeable number of cases from unnecessarily undergoing operation.

CITATION INFORMATION: Lange P, Rudich S, Obaseki N, Punch J. Deceased Organ Donors with Zero Organs Transplanted: Why and How Can We Improve? Am J Transplant. 2016;16 (suppl 3).

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