C. Santino1, K. Ibraheem1, N. Kulvatunyou1, A. Azim1, G. Vercruysse1, A. Tang1, R. Friese1, L. Gries1, T. O’Keeffe1, B. Joseph1 1University Of Arizona,Division Of Trauma, Critical Care, Burns & Emergency Surgery,Tucson, AZ, USA
Introduction:
Trauma care has evolved with several studies demonstrating that patients treated at trauma centers have better outcomes. Trauma patients also form the major pool of organ donors in the United States. However, it is unknown if the distribution of trauma centers has affected organ donation. The aim of this study was to assess the association between trauma center distribution across states and organ donation rates.
Methods:
We performed a one year analysis (2013) of the CDC WISQARS database for all injury related deaths in a state. Number of organ donors after trauma-related death were obtained from the UNOS database. Number of trauma centers and their level of verification (Level I, II, III) in each state were obtained from American College of Surgeons’ (ACS) trauma center registry. Only states with data available for organ donation were included. States were divided into two groups based on the trauma center distribution per million population: high density states (HDS) where trauma center density was greater than the national average and low density states (LDS) where trauma center density was less than the national average. Stepwise linear regression analysis was performed for the predictors of organ donors per million population and organ donors per 100,000 trauma deaths.
Results:
A total of 40 states were included in the analysis with mean trauma center distribution of 5.7 trauma centers per one million population and an organ donation rate of 16.8±12.8 organ donors per one million population. 30 states were included in LDS and 10 in HDS. HDS states had a higher number of total adult trauma centers (5 [2-11] vs. 2 [1-7]; p=0.02), a higher number of level 1 and 2 trauma centers (5 [1-10] vs. 2 [1-5]; p=0.02), and a lower area of coverage per trauma center (p=0.001). HDS states had a higher rate of organ donors per one million population (24.8±21.9 vs. 14.2±6.5;p=0.022) and a higher rate of organ donors per 100,000 trauma deaths (32.2±22.1 vs. 17.4±7.8;p=0.025). On stepwise linear regression analysis, trauma center distribution per million population was independently associated with higher rate of organ donors per one million population (β [95% CI]: 0.38 [0.01-0.49]; p=0.04) and organ donors per trauma death (β [95% CI]: 0.40 [0.03 – 0.59]; p=0.03).
Conclusion:
Regional variability of ACS verified trauma centers significantly impact statewide trauma-related organ donation rate. The findings of this study highlight a correlation between statewide organ donation rates and ACS verified trauma center density.