Facilitation of a Centralized Recovery Center Through Air and Ground Critical Care Transport

Organ transplantation is an operationally complex process. Centralized recovery centers (CRCs) address multiple logistical issues while decreasing costs and increasing organ transplanted per donor (OTPD). This paradigm is predicated on the safe and effective transport of neurologically deceased donors from index facilities. Although the merits of CRCs are well studied, these transport processes have not been well assessed. We set out to evaluate the safety, feasibility, and efficacy of transporting brain-dead organ donors through air and ground critical care transport.

We completed a comprehensive review of our processes and retrospective chart review of all donor transports from index hospitals to the local CRC in an 18-month period. Clinical and transport data were both electronically and manually abstracted from 2 existing databases.

Crews transported 74 donors (32 by air, 42 by ground) resulting in 257 organs transplanted (OTPD3.67). Median operating room time was 237 (interquartile range 205-292) minutes. Donors required a median of 2 (interquartile range 0-3) infusions and a mean norepinephrine equivalent of 0.02 µg/kg/min (standard deviation 0.06). One patient (1.4%) required blood products, 6 (8.1%) developed new hypotension, and 4 (5.4%) had new hypoxemia. There were no cardiac arrests in transport.

Through a thoughtful collaboration between a busy organ procurement organization and well-established regional air and ground critical care transport service, in 18 months our system moved 74 donors from index hospitals to a new CRC for organ procurement. Our experience highlights the feasibility, safety, and efficacy of this cost-effective partnership.