Direct Measurement of DCD Donor Potential

Area of Science:

• Transplantation Medicine
• Organ Donation Research
• Public Health Policy

Background:

• Current organ procurement organization (OPO) performance metrics rely on indirect measures of donation after circulatory death (DCD).
• A direct measurement of OPO donor potential is needed for accurate performance evaluation and regulatory compliance.

Purpose of the Study:

• To categorize and quantify the reasons why potential DCD donors do not progress to organ procurement.
• To establish a direct method for measuring OPO donor potential.

Main Methods:

• Reviewed 18,685 potential organ donor referrals to OneLegacy in 2021-2022.
• Categorized and quantified reasons for cases not proceeding to donation, including chart audits of all hospital deaths to identify missed referrals.

Main Results:

• Identified 8,349 potential DCD donors.
• 5,640 cases were excluded for clinical reasons; 1,458 for DCD-specific factors (e.g., ventilation not withdrawn).
• Only 191 donors proceeded to organ transplantation from 1,251 cases approached for family consent.

Conclusions:

• Directly measured OPO donor potential from referral and death record reviews is significantly lower than administrative data estimates.
• Codifying DCD donor criteria, optimizing electronic donor records, and developing audit processes are crucial for a reliable direct measure of donor potential.