An Assessment of Ineligible Donor Use in Solid Organ Transplant.
| Autor: | DeRoos LJ; Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI., Tapper EB; Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI., Lavieri MS; Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI., Hutton DW; Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI.; Department of Health Management and Policy, University of Michigan, Ann Arbor, MI., Parikh ND; Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI. |
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| Jazyk: | angličtina |
| Zdroj: | Transplantation [Transplantation] 2022 Aug 01; Vol. 106 (8), pp. 1629-1637. Date of Electronic Publication: 2022 Mar 08. |
| DOI: | 10.1097/TP.0000000000004084 |
| Abstrakt: | Background: In the United States, the demand for organ transplants far outpaces available organs. The use of Organ Procurement and Transplantation Network-defined ineligible donors is an immediate method for increasing donations. However, the use of ineligible donors varies across organ procurement organizations (OPOs), and its association with recipient survival remains unclear. Methods: We evaluated ineligible donor use from 2008 to 2020 by OPO and its association with graft and recipient survival across demographics. Results: In this study of 297 223 organ donations, 42 184 (14%) did not meet eligibility criteria as defined by the Organ Procurement and Transplantation Network. Log-rank tests on Kaplan-Meier curves suggested differences in graft and patient survival between eligible and ineligible recipients for kidney and liver transplants ( P ≤ 0.01 for all). Recipients of ineligible kidney and liver donations saw a 2.20% and 9.38% decrease in 10-y graft survival probability, respectively. There were no statistically significant graft and patient survival differences for recipients of ineligible heart, lung, and pancreas donations. Multivariate proportional hazard models showed eligibility was associated with kidney, liver, and lung graft survival ( P ≤ 0.02 for all). However, if OPOs increased ineligible donor use to meet the current 75th percentile use rate, there could be as many as 1000 transplants and 6291 life-years gained annually. Conclusions: Ineligible donor use can provide significant survival benefit for patients who would otherwise never receive a transplant. Methods to reduce regional heterogeneity in ineligible donor use could increase the number of transplants and improve outcomes for waiting patients. Competing Interests: The authors declare no funding or conflicts of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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