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Donor Management Task Force Metrics


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DAVID P NELSON, MD
ISHLT HFTM Council Communications Liaison
Chief, Heart Transplant Medicine Division
INTEGRIS Nazih Zuhdi Transplant Institute
Oklahoma City, Oklahoma, USA

david.nelson@integris-health.com


Donor management research studies are often designed by professionals with an intensivist/OPO focus or transplanters with a single organ focus. The impact of investigational donor interventions on all allocated organs is usually under reported. To improve this, the HRSA Donor Management Task Force (DMTF), which includes ISHLT heart and lung members, asked the ISHLT to develop heart and lung outcome metrics to guide donor management investigators. The same request was made for abdominal organs to the AST and now includes ASTS participation.

The goal of the metrics is to identify outcome measures that thoracic transplanters would like collected on thoracic recipients of donors who have been subjected to a research intervention. It is not the DMTF's expectation that all of these metrics would be collected on every donor management research trial, but that they provide a guideline to those developing such studies with the recognition that funding and other practical concerns will limit the outcome metrics collected. The intervals of 60 days, 6 months, 12 months and 36 months were selected to correlate with UNOS forms in the hope that at least some of the metrics could be captured on current or future forms. It was requested that the number of metrics be limited to 10 for each organ (heart and lung).

Both the ISHLT Heart Failure and Transplant Medicine and Pulmonary Transplantation Scientific Councils formed DMTF Metrics Work Groups at the 2011 ISHLT meeting in San Diego. The members of the Heart Work Group are Kiran Khush, Ram Kalya, Jeff Hosenpud, Dave Baran, Richard Daley, Hannah Valantine and myself. The members of the Lung Work Group are Luis Angel, Remzi Bag, Scott Palmer, Ramsey Hachem and myself. Kiran Khush, Luis Angel and I are also members of the DMTF.

Both work groups creatively extended the metrics to include donor information, which they believed important to interpret the effect of donor interventions on recipient outcomes. The heart metrics, which include "major primary graft dysfunction," also include a proviso noting that an expert panel on Primary Graft Dysfunction will be led by Dr. Jon Kobashigawa in conjunction with the annual ISHLT meeting in April 2013 and recommend that the definition of Primary Graft Dysfunction on the metrics document should undergo a future update to reflect the definition accepted by that expert panel.

Both the Heart and Lung Work Groups have forwarded the completed metrics to Scientific Council chairs, Brad Dyke and David Weill, as well as to the ISHLT Standards & Guidelines Committee for review. Look for another status update to come soon.



Disclosure Statement: The author has no conflicts of interest to disclose.