Ten-year retrospective review of transfusion practices in beating-heart organ donors

Recent studies suggest that restrictive transfusion strategies are equivocal or noninferior to liberal strategies in various patient populations; however, evidence for the optimal transfusion threshold or current transfusion practice in beating-heart organ donors is lacking. A 10-year retrospective analysis of blood product utilization in beating-heart organ donors was performed to determine current transfusion practice.

An institutional review board-approved retrospective review of 439 beating-heart organ donors from January 1, 2004, to October 1, 2014, was performed. For each donor, hemoglobin (Hb), platelet (PLT), prothrombin time/international normalized ratio (PT/INR), and fibrinogen levels as well as all transfusion reaction reports were recorded from the time of declaration of brain death to organ procurement.

Red blood cell transfusion occurred in 304 donors (69.2%), with a trough Hb level of more than 8 g/dL in 63.2% and more than 10 g/dL in 15.8%; final Hb was more than 10 g/dL in 44.1% of transfused donors. PLT transfusion occurred in 165 donors (37.6%), with a trough PLT count of more than 50 × 10(9) /L in 113 (68.5%) and more than 100 × 10(9) /L in 15 (9.1%). Plasma transfusion occurred in 217 donors (49.4%), with a peak INR of less than 1.5 in 75 donors (34.6%) and a peak INR of 1.6 to 2.0 in 112 donors (51.6%). Only 17.4% of donors who received cryoprecipitate had fibrinogen levels measured, and results were all more than 200 mg/dL. Transfusion reactions were underreported (p = 0.0001).

This study suggests potential suboptimal use of limited biologic resources in beating-heart organ donors, as well as significant underreporting of suspected transfusion reactions. Additional studies are indicated to determine optimal transfusion thresholds in this population.