Trends in donation after circulatory determination of death donor utilization: Lessons from Houston

• Published in: Transplantation reports 2023-06, Vol.8 (2), p.100135, Article 100135
• Main Authors: Barboza, Andrew B., Dhanani, Naila H, Browning, Kristine, Wood, R. Patrick, Hall, David R
• Format: Article
• Language: English
• Subjects: Donation after cardiac death; Organ donation; Organ shortage
• ISSN: 2451-9596; 2451-9596
• DOI: 10.1016/j.tpr.2023.100135

•There have been progressive increases in the number of patients awaiting organ transplant in the United States, resulting in rising waiting time to transplant.•A promising option to increase available organ allografts has been the use of organs from Donation after Circulatory Determination of Death (DCD) donors.•Individual Organ Procurement Organizations (OPOs) have changing utility of DCD donors, related to logistic and ethical issues surrounding this type of donation•DCDD donors have increased by 10% in recent years at LifeGift, despite the logistic and ethical challenges surrounding this type of donor.•United Network for Organ Sharing (UNOS) surveillance metrics for OPOs can be improved to better assess DCD donor utilization. Modern advancements have made organ transplantation an increasingly viable option for patients with organ failure. The resulting increases in patients awaiting transplant has resulted in significant morbidity and mortality due to increasing waiting time for transplant. The use of Donation after Circulatory Determination of Death (DCD) organ donors has been the most successful avenue to address the increased need for organ allografts. This review provides a brief history of DCD organ donation in the United States as represented by the experience of the Houston-based LifeGift Organ Procurement Organization (OPO). Organ donation data from the Scientific Registry of Transplant Recipients (SRTR) and OPO specific data to include all available DCD donors for LifeGift were obtained for analysis. Trends in DCD donation were analyzed in the context of United Network for Organ Sharing policy. By the end of 2021 20% of organs donated in the United States were from DCD donors, in a steadily increasing trend since the mid-1990′s. Metrics utilized by UNOS to monitor organ donation rates and OPO performance do not clearly capture potential DCD donors. Individual OPOs have varying success in utilization of DCD donors, with OPOs like LifeGift focusing on increased DCD utilization. DCD utilization remains the most successful avenue for increasing the deceased donor organ pool in the United States. Increased utilization of DCD organs by transplant centers and focused efforts by OPOs to promote DCD donation can improve the organ shortage nationally. Improved clarity in UNOS metrics can further facilitate OPO performance evaluation and promote further DCD donation in the United States.