Standardization of transfusion practice in organ donors using the Digital Intern, an electronic decision support...

Area of Science:

• Organ transplantation and donor management
• Transfusion medicine and hematology
• Medical informatics and artificial intelligence

Background:

• Restrictive red blood cell (RBC) transfusion thresholds are supported by clinical trials.
• Nonsurvivable organ donors are crucial for transplantation.
• The Digital Intern (DI) algorithm standardizes donor care with a restrictive transfusion threshold, but its impact on organ donors was unreported.

Purpose of the Study:

• To evaluate the impact of the Digital Intern (DI) algorithm on red blood cell (RBC) transfusion practices in organ donors.
• To compare transfusion rates, volume, and variability between DI-managed and physician-managed donors.
• To assess the effect of DI-guided transfusion on the number of transplanted organs per donor.

Main Methods:

• Retrospective cohort study comparing DI (n=100) to physician-managed donors (n=90).
• Analysis of transfusion rates, units transfused, pretransfusion hematocrit, and parameter variability.
• Comparison of transplanted organs per donor between the two groups.

Main Results:

• No significant difference in donor time between groups (25.9 ± 15.2 hours).
• Lower transfusion rates (19% vs. 26%) and fewer units per transfusion (1 vs. 2) in the DI group (p=0.03).
• Lower pretransfusion hematocrit (23% vs. 27%, p=0.01) and reduced variability in transfusion parameters in the DI group.
• Similar numbers of transplanted organs per donor (3.24 vs. 3.03, p=0.37).

Conclusions:

• The Digital Intern algorithm standardizes transfusion practices in organ donors.
• DI implementation leads to reduced red blood cell (RBC) utilization.
• Standardized, restrictive transfusion protocols using DI do not compromise the number of transplantable organs.