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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Veröffentlicht in:American journal of transplantation Jg. 24; H. 10; S. 1803 - 1815
Hauptverfasser: 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
Sprache:Englisch
Veröffentlicht: United States Elsevier Inc 01.10.2024
Schlagworte:
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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Zusammenfassung: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.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1600-6135
1600-6143
1600-6143
DOI:10.1016/j.ajt.2024.03.027