links header
  email icon  Email     printer icon  PDF

Donor Management Research Update:
Growing Links Between Donor Management and
Transplant Communities


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

DARRIN MALINOSKI, MD
Section Chief, Surgical Critical Care
Portland VA Medical Center
Associate Professor of Surgery
Oregon Health & Science University
Portland, Oregon, USA

Darren.malinoski@va.gov


Conducting the research necessary to guide evidence-based donor management is challenged by multiple obstacles unique to organ recovery. Whatever is done to a donor affects the acceptance decisions of transplant teams and could affect recipient outcomes. A partnership between the donor management and transplant recipient communities is crucial in developing the policies and procedures necessary to facilitate productive, practical, and safe donor research. Two examples of this partnering are the HRSA Donor Management Task Force (DMTF) and the ASTS Donor Research Initiative.

HRSA Donor Management Task Force (DMTF):
The DMTF has representation from the OPO, critical care, and transplant communities. UNOS President John Roberts of UCSF just stepped down as DMTF co-chair to better serve his new UNOS commitment. The task force consists of three committees: Scientific Knowledge, Donation Service Area (DSA) Best Practices, and Declaration of Death. Several ISHLT members serve on the DMTF including Kirin Khush (Heart), Luis Angel (Lung), and myself (both Heart and Lung).

1)  The Scientific Knowledge Committee is engaged in two projects involving ISHLT members and thoracic issues: The Outcome Metrics Project and the Donor Heart Management Project. Both of these are reported in more detail elsewhere in this issue. The Metrics Project includes work groups in both the Heart and Lung Scientific Councils of the ISHLT.

2)  The DSA Best Practices Committee just completed a two-year process of creating an online, open-access Toolbox that contains over 400 examples of best practices and resources for donor hospitals and organ procurement organizations to utilize in real time to assist in donor management and increased organ availability. The documents were assembled from high performing OPOs and donor hospitals from around the country and were grouped into the following folders:

  • Brain Death Declaration
  • Catastrophic Brain Injury Guidelines (CBIGs)
  • Checklists
  • Donation After Circulatory Determination of Death
  • Donor Designation
  • Donor Hospital Information
  • Donor Management
  • Electronic Medical Records
  • Intensivist Models
  • Hospital Development
  • Pediatrics
  • Policies for Evolving Practices
  • Quality Improvement
  • Regulatory References
  • Survey Readiness

The DSA Best Practices Committee will continue to update the toolbox periodically throughout the year and will begin directing its attention towards creating an educational module on organ donation that can be incorporated into nursing, medical student, and resident training programs. The toolbox can be accessed at the following site: http://www.healthcarecommunities.org/DonationToolbox/

3)  The purposes of the Declaration of Death Committee are to promote timely declaration of death using the most appropriate donation pathway (donation after neurologic determination of death [DNDD] or donation after circulatory determination of death [DCDD]) and to develop strategies that preserve the possibility of donation and/or honor donation intentions and preserve organ viability when the possibility of neurologic death is not certain or has not yet occurred. Recent initiatives have involved raising awareness of and training with the 2010 American Academy of Neurology (AAN) Practice Parameters for the Declaration of Neurologic Death.

ASTS Donor Research Initiative:
Spearheading the ASTS's interest in donor research was a Mini-review by UCSF's Sandy Feng in AJT 2010:10:1155-62 titled "Donor Intervention and Organ Preservation: Where is the science and what are the obstacles?" In 2012, a preliminary ASTS White Paper regarding this subject was written by a special ASTS group including Sandy Feng, Peter Abt and other prominent ASTS members. Donor and recipient consent, oversight by a national and/or regional review board, local IRB role, potential use of DonorNet for posting study information with organ offers, and the effect on allocation were some of the issues explored. Input from stakeholder organizations was obtained about the draft, and a meeting with representatives of these groups including ASTS, AST, SCCM, AOPO, and the ODRC occurred at the 2012 ATC in Boston. Eventual White Paper publication is anticipated. Implementation of one of its recommendations—to hold a consensus conference on donor management research—is being explored.



Disclosure Statements:
David Nelson has no conflicts of interest to disclose.
Darrin Malinoski receives consulting fees from the Organ Donation and Transplantation Alliance.