S. Gotewal1, C. Hwang1, J. Reese1, M. MacConmara1 1University Of Texas Southwestern Medical Center,Transplant,Dallas, TX, USA
Introduction: In 2014, a novel approach to organ procurement was initiated by the organ procurement organization (OPO) in the North Texas by hiring a full-time donor surgeon. The intent was to increase utilization and enhance distribution of organs. The aim of our study was to investigate the impact of the independent OPO surgeon on discard rates and patterns of organ use.
Methods: A retrospective review of the OPO donor database identified all procurement cases from the North Texas DSA, between January 1, 2013 and September 30, 2015. Basic donor demographic data, donor serologies and intraoperative variables were collected. Marginal donor status was determined by identifying age >65, macrovesicular fat>30%, cold ischemia time> 8 hrs, HBV status, HCV status, AST enzyme levels>500, sodium levels>170, liver segment use, or donation after cardiac death (DCD) donor. In addition, we calculated the cumulative number of marginal characteristics associated with each donor (marginal liver score). The presence of the OPO surgeon as assistant or primary surgeon was identified. Organ disposition codes and sharing codes were obtained to evaluate patterns of utilization.
Results: There were 711 liver procurements done during the period of study with a discard rate of 11.7%. There was no difference in the discard rate in the time period before or after the OPO surgeons arrival (12.2% vs. 11.3%). The OPO surgeon was present for 208 donor surgeries (29.3%), however there was a higher rate of discard when the OPO surgeon was present (13.5% vs. 10.2%, p<0.001) and this was not explained by age, macrovesicular fat content or cold ischemia time differences. The OPO surgeon procured livers from more DCD donors although this represented only small fraction of the total donor surgeries.
Marginal donors were procured by OPO and non-OPO surgeons at equal frequency, however the cases at which the OPO surgeon was present had much greater complexity (as determined by marginal score) and the rate of discard was significantly less when the OPO surgeon was present at these cases (22% vs. 47%, P<0.01) The OPO surgeon was also associated with a higher number of regional and national shared organs (54% vs. 26%).
Conclusion: The addition of a dedicated full-time OPO surgeon has changed the pattern of utilization of the donor livers in North Texas. It has decreased the discard rate of livers from patients with multiple marginal characteristics and this has lead to 18 additional livers being transplanted per year since initiation of the OPO surgeon.