When Only One of Paired Organs Are Transplanted: Is there a missed transplant opportunity?

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Abstract

Background

One U.S. organ procurement organization (OPO) noticed a number of incidences where one organ from a set of paired organs (lungs, kidneys) were transplanted with good outcome but the other organ from the pair (“mate”) was not utilized. We sought to determine the frequency with which a clinically similar organ was not utilized when a mate organ was transplanted.

Method

A two-year retrospective review was performed and all paired organs where one organ was transplanted and one was not were reviewed. Cases were analyzed to determine if there was an obvious reason the mate was not used (trauma, biopsy, aberrant anatomy). In cases where no obvious reason existed, the outcome of the transplanted organ was noted.

Results

In 2015/2016, the OPO recovered 354 deceased organ donors. 248 (70.1%) were brain dead (DBD) and 106 (29.9%) were DCD. There were 40 donors (11.3%) which had 41 pairs of organs with an outcome of one transplanted, one discarded. Of the 41 pairs, 27 involved kidney pairs (65.9%) and 14 involved lung pairs (34.1%); 27 were DBD, 14 were DCD. Kidney pairs were DBD=13 and DCD=14; lung pairs were DBD=14, DCD=0. Upon review 22 of the 41 pairs (53.7%) had a clear clinical reason for non-utilization of one organ: renal biopsy=6, pre-donation trauma=3, anatomy=2, donor work up (i.e., infiltrates in one lung) =5, issues on visualization in OR (lungs)=6. The remaining 19 were not different in a clinically significant way but were unused. Of the 19, 17 (89.5%) were kidneys (DBD=8, DCD=9) and 2 were lungs (DBD=2, DCD=0). Reasons for non-use were: known donor variables not unique to organ not transplanted=13, recipient center issues=3, logistics=2, unknown=1. Of note all transplanted mates were functioning at time of analysis.

Discussion/Conclusions

Our most recent two-year experience is that slightly more than 1 in 10 deceased donors (11.3%) will have one paired organ transplanted while its mate is not utilized. Of these cases, 46.3% appear to have no clinically unique data that results in non-utilization; known donor variables not unique to the unused organ (such as an HCV+ donor) represent 68.4% of the reasons documented by the transplant center/OPO for non-utilization. The remainder are lost due to logistics or issues at the recipient center. Our data indicate roughly half of unused mate organs are lost for known or non-clinical variables and thus could potentially be transplanted. A broader, multi-center study is recommended.

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