State of the Science in Deceased Organ Donor Management
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Purpose of Review
Research in deceased organ donor management offers an opportunity to increase the quantity and quality of organs available for transplantation. This article aims to appraise the current literature with a focus on reviewing deceased donor intervention trials.
Aggressive critical care management after determination of brain death resulting in meeting of a donor management goal bundle has consistently demonstrated an association with significantly more organs transplanted per donor as well as improved graft outcomes. Although there is a dearth of experience with randomized donor intervention studies, dopamine and targeted mild therapeutic hypothermia have been found to significantly reduce delayed graft function in kidney recipients.
Progress in understanding the ethical, legal, regulatory, policy, and organizational elements of organ donor research has provided a mechanism that allows for the endorsement of potentially impactful donor management studies. Ongoing trials should incorporate methods to ensure safety to all organs donated from donors enrolled in interventional trials.
KeywordsDeceased organ donor Organ donor management Donor intervention research Organ donor clinical trial
This work was supported in part by the Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.
Compliance with Ethical Standards
Conflict of Interest
Madhukar Patel, Mitchell Sally, and Claus Niemann declare no conflict of interest. Darren Malinoski reports grants from the Laura and John Arnold Foundation, during the conduct of the study.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance
- 2.•• Kotloff RM, Blosser S, Fulda GJ, Malinoski D, Ahya VN, Angel L, et al. Management of the potential organ donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement. Crit Care Med. 2015;43(6):1291–325. Consensus statement providing practical recommendations to aid critical care practitioners in the management of potential organ donors. PubMedCrossRefGoogle Scholar
- 3.Malinoski DJ, Patel MS, Ahmed O, Daly MC, Mooney S, Graybill CO, et al. The impact of meeting donor management goals on the development of delayed graft function in kidney transplant recipients. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2013;13(4):993–1000.CrossRefGoogle Scholar
- 4.Malinoski DJ, Patel MS, Daly MC, Oley-Graybill C, Salim A. The impact of meeting donor management goals on the number of organs transplanted per donor: results from the United Network for Organ Sharing Region 5 prospective donor management goals study. Crit Care Med. 2012;40(10):2773–80.PubMedCrossRefGoogle Scholar
- 8.• Patel MS, De La Cruz S, Sally MB, Groat T, Malinoski DJ. Active donor management during the hospital phase of care is associated with more organs transplanted per donor. J Am Coll Surg. 2017;225(4):525–31. Prospective observational study demonstrating a substantial increase in organs transplanted per donor with active critical care of the potential organ donor. PubMedCrossRefGoogle Scholar
- 9.Critical Pathway for the Organ Donor [Available from: https://www.unos.org/wp-content/uploads/unos/Critical_Pathway.pdf.
- 12.•• Souter MJ, Blissitt PA, Blosser S, Bonomo J, Greer D, Jichici D, et al. Recommendations for the critical care management of devastating brain injury: prognostication, psychosocial, and ethical management : a position statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care. 2015;23(1):4–13. Position statement to help guide management during the first 72 h after devastating brain injury. PubMedCrossRefGoogle Scholar
- 15.•• Niemann CU, Feiner J, Swain S, Bunting S, Friedman M, Crutchfield M, et al. Therapeutic hypothermia in deceased organ donors and kidney-graft function. N Engl J Med. 2015;373(5):405–14. Randomized controlled trial demonstrating the impact of therapeutic hypotermia in the decased organ donor on signficantly decreasing delayed kidney graft function in recipients. PubMedCrossRefGoogle Scholar
- 19.•• National Academies of Sciences E, Medicine. Opportunities for organ donor intervention research: saving lives by improving the quality and quantity of organs for transplantation. In: Childress JF, Domnitz S, Liverman CT, editors. . Washington, DC: The National Academies Press; 2017. 220 p. Report discussing the ethical, legal, regulatory, policy, and organizational elements of organ donor research, and endorsing the need for further coordination and design of donor intervention studies. Google Scholar
- 22.Schnuelle P, Mundt HM, Druschler F, Schmitt WH, Yard BA, Kramer BK, et al. Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation. Am J Transplant. 2018;18(3):704–14.Google Scholar
- 23.•• Schnuelle P, Schmitt WH, Weiss C, Habicht A, Renders L, Zeier M, et al. Effects of dopamine donor pretreatment on graft survival after kidney transplantation: a randomized trial. Clin J Am Soc Nephrol. 2017;12(3):493–501. Five-year follow-up of renal transplant patients participating in dopamine donor pretreatment clinical trial showing no signficant graft survival advanatage on intention-to-treat analysis but noting an exposure-response relationship which may provide advanatage to a subset. PubMedPubMedCentralCrossRefGoogle Scholar
- 24.Benck U, Hoeger S, Brinkkoetter PT, Gottmann U, Doenmez D, Boesebeck D, et al. Effects of donor pre-treatment with dopamine on survival after heart transplantation: a cohort study of heart transplant recipients nested in a randomized controlled multicenter trial. J Am Coll Cardiol. 2011;58(17):1768–77.PubMedCrossRefGoogle Scholar
- 27.Schnuelle P, Benck U, Yard BA. Dopamine in transplantation: written off or comeback with novel indication? Clin Transpl. 2018:e13292.Google Scholar