Association of procurement technique with organ yield and cost following donation after circulatory death

Donation after circulatory death (DCD) could account for the largest expansion of the donor allograft pool in the contemporary era. However, the organ yield and associated costs of normothermic regional perfusion (NRP) compared to super-rapid recovery (SRR) with ex-situ normothermic machine perfusio...

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Published in:	American journal of transplantation Vol. 24; no. 10; pp. 1803 - 1815
Main Authors:	Bakhtiyar, Syed Shahyan, Maksimuk, Tiffany E., Gutowski, John, Park, Sarah Y., Cain, Michael T., Rove, Jessica Y., Reece, T. Brett, Cleveland, Joseph C., Pomposelli, James J., Bababekov, Yanik J., Nydam, Trevor L., Schold, Jesse D., Pomfret, Elizabeth A., Hoffman, Jordan R.H.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01.10.2024
Subjects:	Adult Aged Brain Death Costs and Cost Analysis DBD DCD Direct procurement and perfusion Donation after brain death Donation after circulatory death DPP Female Humans Hypothermic machine perfusion Male Middle Aged Normothermic machine perfusion Normothermic regional perfusion NRP OPTN Organ Preservation - economics Organ Preservation - statistics & numerical data Organ procurement and transplantation network Organ Transplantation - economics Organ Transplantation - statistics & numerical data Perfusion Shock - epidemiology SRR Super-rapid recovery Tissue and Organ Harvesting - economics Tissue and Organ Harvesting - statistics & numerical data Tissue and Organ Procurement - economics Tissue and Organ Procurement - methods Tissue and Organ Procurement - statistics & numerical data Tissue Donors - statistics & numerical data SCS DCD AOR DPP CI DBD HMP Super-rapid recovery NRP NMP Donation after circulatory death SRR Normothermic regional perfusion Direct procurement and perfusion Donation after brain death Hypothermic machine perfusion Organ procurement and transplantation network OPTN Normothermic machine perfusion
ISSN:	1600-6135, 1600-6143, 1600-6143
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Abstract	Donation after circulatory death (DCD) could account for the largest expansion of the donor allograft pool in the contemporary era. However, the organ yield and associated costs of normothermic regional perfusion (NRP) compared to super-rapid recovery (SRR) with ex-situ normothermic machine perfusion, remain unreported. The Organ Procurement and Transplantation Network (December 2019 to June 2023) was analyzed to determine the number of organs recovered per donor. A cost analysis was performed based on our institution’s experience since 2022. Of 43 502 donors, 30 646 (70%) were donors after brain death (DBD), 12 536 (29%) DCD-SRR and 320 (0.7%) DCD-NRP. The mean number of organs recovered was 3.70 for DBD, 3.71 for DCD-NRP (P < .001), and 2.45 for DCD-SRR (P < .001). Following risk adjustment, DCD-NRP (adjusted odds ratio 1.34, confidence interval 1.04-1.75) and DCD-SRR (adjusted odds ratio 2.11, confidence interval 2.01-2.21; reference: DBD) remained associated with greater odds of allograft nonuse. Including incomplete and completed procurement runs, the total average cost of DCD-NRP was $9463.22 per donor. By conservative estimates, we found that approximately 31 donor allografts could be procured using DCD-NRP for the cost equivalent of 1 allograft procured via DCD-SRR with ex-situ normothermic machine perfusion. In conclusion, DCD-SRR procurements were associated with the lowest organ yield compared to other procurement methods. To facilitate broader adoption of DCD procurement, a comprehensive understanding of the trade-offs inherent in each technique is imperative.
AbstractList	Donation after circulatory death (DCD) could account for the largest expansion of the donor allograft pool in the contemporary era. However, the organ yield and associated costs of normothermic regional perfusion (NRP) compared to super-rapid recovery (SRR) with ex-situ normothermic machine perfusion, remain unreported. The Organ Procurement and Transplantation Network (December 2019 to June 2023) was analyzed to determine the number of organs recovered per donor. A cost analysis was performed based on our institution's experience since 2022. Of 43 502 donors, 30 646 (70%) were donors after brain death (DBD), 12 536 (29%) DCD-SRR and 320 (0.7%) DCD-NRP. The mean number of organs recovered was 3.70 for DBD, 3.71 for DCD-NRP (P < .001), and 2.45 for DCD-SRR (P < .001). Following risk adjustment, DCD-NRP (adjusted odds ratio 1.34, confidence interval 1.04-1.75) and DCD-SRR (adjusted odds ratio 2.11, confidence interval 2.01-2.21; reference: DBD) remained associated with greater odds of allograft nonuse. Including incomplete and completed procurement runs, the total average cost of DCD-NRP was $9463.22 per donor. By conservative estimates, we found that approximately 31 donor allografts could be procured using DCD-NRP for the cost equivalent of 1 allograft procured via DCD-SRR with ex-situ normothermic machine perfusion. In conclusion, DCD-SRR procurements were associated with the lowest organ yield compared to other procurement methods. To facilitate broader adoption of DCD procurement, a comprehensive understanding of the trade-offs inherent in each technique is imperative. Donation after circulatory death (DCD) could account for the largest expansion of the donor allograft pool in the contemporary era. However, the organ yield and associated costs of normothermic regional perfusion (NRP) compared to super-rapid recovery (SRR) with ex-situ normothermic machine perfusion, remain unreported. The Organ Procurement and Transplantation Network (December 2019 to June 2023) was analyzed to determine the number of organs recovered per donor. A cost analysis was performed based on our institution's experience since 2022. Of 43 502 donors, 30 646 (70%) were donors after brain death (DBD), 12 536 (29%) DCD-SRR and 320 (0.7%) DCD-NRP. The mean number of organs recovered was 3.70 for DBD, 3.71 for DCD-NRP (P < .001), and 2.45 for DCD-SRR (P < .001). Following risk adjustment, DCD-NRP (adjusted odds ratio 1.34, confidence interval 1.04-1.75) and DCD-SRR (adjusted odds ratio 2.11, confidence interval 2.01-2.21; reference: DBD) remained associated with greater odds of allograft nonuse. Including incomplete and completed procurement runs, the total average cost of DCD-NRP was $9463.22 per donor. By conservative estimates, we found that approximately 31 donor allografts could be procured using DCD-NRP for the cost equivalent of 1 allograft procured via DCD-SRR with ex-situ normothermic machine perfusion. In conclusion, DCD-SRR procurements were associated with the lowest organ yield compared to other procurement methods. To facilitate broader adoption of DCD procurement, a comprehensive understanding of the trade-offs inherent in each technique is imperative.Donation after circulatory death (DCD) could account for the largest expansion of the donor allograft pool in the contemporary era. However, the organ yield and associated costs of normothermic regional perfusion (NRP) compared to super-rapid recovery (SRR) with ex-situ normothermic machine perfusion, remain unreported. The Organ Procurement and Transplantation Network (December 2019 to June 2023) was analyzed to determine the number of organs recovered per donor. A cost analysis was performed based on our institution's experience since 2022. Of 43 502 donors, 30 646 (70%) were donors after brain death (DBD), 12 536 (29%) DCD-SRR and 320 (0.7%) DCD-NRP. The mean number of organs recovered was 3.70 for DBD, 3.71 for DCD-NRP (P < .001), and 2.45 for DCD-SRR (P < .001). Following risk adjustment, DCD-NRP (adjusted odds ratio 1.34, confidence interval 1.04-1.75) and DCD-SRR (adjusted odds ratio 2.11, confidence interval 2.01-2.21; reference: DBD) remained associated with greater odds of allograft nonuse. Including incomplete and completed procurement runs, the total average cost of DCD-NRP was $9463.22 per donor. By conservative estimates, we found that approximately 31 donor allografts could be procured using DCD-NRP for the cost equivalent of 1 allograft procured via DCD-SRR with ex-situ normothermic machine perfusion. In conclusion, DCD-SRR procurements were associated with the lowest organ yield compared to other procurement methods. To facilitate broader adoption of DCD procurement, a comprehensive understanding of the trade-offs inherent in each technique is imperative.
Author	Hoffman, Jordan R.H. Pomposelli, James J. Cleveland, Joseph C. Park, Sarah Y. Rove, Jessica Y. Pomfret, Elizabeth A. Maksimuk, Tiffany E. Schold, Jesse D. Gutowski, John Cain, Michael T. Bababekov, Yanik J. Nydam, Trevor L. Bakhtiyar, Syed Shahyan Reece, T. Brett
Author_xml	– sequence: 1 givenname: Syed Shahyan surname: Bakhtiyar fullname: Bakhtiyar, Syed Shahyan email: syed.shahyanbakhtiyar@gmail.com organization: Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA – sequence: 2 givenname: Tiffany E. surname: Maksimuk fullname: Maksimuk, Tiffany E. organization: Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA – sequence: 3 givenname: John surname: Gutowski fullname: Gutowski, John organization: University of Colorado Hospital Transplant Center, Aurora, Colorado, USA – sequence: 4 givenname: Sarah Y. surname: Park fullname: Park, Sarah Y. organization: Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA – sequence: 5 givenname: Michael T. orcidid: 0000-0003-4029-2557 surname: Cain fullname: Cain, Michael T. organization: Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA – sequence: 6 givenname: Jessica Y. surname: Rove fullname: Rove, Jessica Y. organization: Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA – sequence: 7 givenname: T. Brett surname: Reece fullname: Reece, T. Brett organization: Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA – sequence: 8 givenname: Joseph C. surname: Cleveland fullname: Cleveland, Joseph C. organization: Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA – sequence: 9 givenname: James J. orcidid: 0000-0002-1291-3312 surname: Pomposelli fullname: Pomposelli, James J. organization: University of Colorado Hospital Transplant Center, Aurora, Colorado, USA – sequence: 10 givenname: Yanik J. surname: Bababekov fullname: Bababekov, Yanik J. organization: University of Colorado Hospital Transplant Center, Aurora, Colorado, USA – sequence: 11 givenname: Trevor L. orcidid: 0009-0001-9033-5140 surname: Nydam fullname: Nydam, Trevor L. organization: University of Colorado Hospital Transplant Center, Aurora, Colorado, USA – sequence: 12 givenname: Jesse D. orcidid: 0000-0002-5341-7286 surname: Schold fullname: Schold, Jesse D. organization: Division of Transplant Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA – sequence: 13 givenname: Elizabeth A. orcidid: 0000-0001-7970-1325 surname: Pomfret fullname: Pomfret, Elizabeth A. organization: University of Colorado Hospital Transplant Center, Aurora, Colorado, USA – sequence: 14 givenname: Jordan R.H. orcidid: 0000-0003-3359-5277 surname: Hoffman fullname: Hoffman, Jordan R.H. organization: Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
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Keywords	SCS DCD AOR DPP CI DBD HMP Super-rapid recovery NRP NMP Donation after circulatory death SRR Normothermic regional perfusion Direct procurement and perfusion Donation after brain death Hypothermic machine perfusion Organ procurement and transplantation network OPTN Normothermic machine perfusion
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Snippet	Donation after circulatory death (DCD) could account for the largest expansion of the donor allograft pool in the contemporary era. However, the organ yield...
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SubjectTerms	Adult Aged Brain Death Costs and Cost Analysis DBD DCD Direct procurement and perfusion Donation after brain death Donation after circulatory death DPP Female Humans Hypothermic machine perfusion Male Middle Aged Normothermic machine perfusion Normothermic regional perfusion NRP OPTN Organ Preservation - economics Organ Preservation - statistics & numerical data Organ procurement and transplantation network Organ Transplantation - economics Organ Transplantation - statistics & numerical data Perfusion Shock - epidemiology SRR Super-rapid recovery Tissue and Organ Harvesting - economics Tissue and Organ Harvesting - statistics & numerical data Tissue and Organ Procurement - economics Tissue and Organ Procurement - methods Tissue and Organ Procurement - statistics & numerical data Tissue Donors - statistics & numerical data
Title	Association of procurement technique with organ yield and cost following donation after circulatory death
URI	https://dx.doi.org/10.1016/j.ajt.2024.03.027 https://www.ncbi.nlm.nih.gov/pubmed/38521350 https://www.proquest.com/docview/2974006966
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