Practice Variation in Intraoperative Management of Pediatric Organ Donation After Brain Death: A Retrospective...

There remains a critical shortage of pediatric organ donors and there is a gap in understanding of optimal perioperative management to optimize donor organ outcomes for this valuable resource.

To survey practice patterns for intraoperative management of pediatric (age < 18 years) brain-dead donors during organ recovery procedures.

This retrospective observational study included organ recovery cases from 24 centers included in the Multicenter Perioperative Outcomes Group (MPOG) cohort in the United States from 2014 to 2020. Practice variation was evaluated using descriptive statistics, Fleiss' kappa, and logistic regression for between-group comparisons for volume-based analysis (case volume < 10 or ≥ 10) without adjustment for multiple comparisons.

A total of 231 cases were included in this analysis. The median case volume for the Higher-Volume (≥ 10 cases) group was 25 [IQR 17, 46] cases and 7 [IQR 3, 8] cases for the Lower-Volume (< 10 cases) group. Descriptive analyses identified differences in case volume, race, and administration of steroids and vasoactives (bolus and infusion). The Fleiss' kappa scores were negative across all medications administered, suggesting a lack of within-group agreement. The odds ratio for steroid administration in the Lower-Volume group was 0.319 (95% CI: 0.116-0.745, p = 0.014).

This study found substantial practice variation across MPOG centers grouped based on case volume frequency for organ recovery procedures in pediatric donation after brain death. A major limitation of this study is the inability to correlate perioperative management with organ recipient outcomes. The main takeaway is an opportunity to improve consistency in perioperative management for brain-death donors from case classification to medication administration that reflects an understanding of brain death physiology.