A national policy change aimed at promoting wider sharing of donor livers through a “circle of acuity” has led to delays in procurement, according to a researcher at the University of Miami’s Miller School of Medicine.
By expanding the geographic area in which donor livers are shared, acuity circles increase the number of “local” transplant recipient centers, expand travel arrangements, and increase the complexity of organ procurement organizations that coordinate the process. While the resulting delays average only a few hours, in some cases policy changes can add a day or two to the procurement process. “
David Goldberg, MD, Associate Professor of Medicine, Division of Digestive Health and Hepatology
Dr. Goldberg is the lead author of the study “The Effect of Liver Sensitivity Circle on Donor Procurement Time” recently published in JAMA Surgery. Co-authors are Ramya Radhkkrishnan and Darius Chyou, students of the Miller School of Medicine.
Policy expands to transplant hospitals
On February 4, 2020, the United Network for Organ Sharing (UNOS), a non-profit organization of the national transplant system, implemented a “circle of vision”-based liver and intestinal distribution changes, expanding the geographic area to 150 of the transplant hospitals in the territory of donating hospitals. , 250 or 500 nautical miles. According to UNOS, the policy aims to reduce pre-transplant deaths, increase pediatric transplants, and reduce geographic disparities in medical urgency scores at the time of transplant.
“Under this policy, donor livers from New York City hospitals will be provided to transplant centers from Baltimore to Boston, not just nearby sites,” Dr. Goldberg said. “As a result, more centers need to be responsive to procurement options, leading to delays in procurement, which can be emotionally taxing on family members waiting for organ removal. It can also increase hospital operating costs because of donor beds. occupied longer in the intensive care unit.”
Longer delays in multiple organ transplants
Dr. Goldberg noted that the procurement process becomes more complicated when the donation includes the kidney or intestine as well as the liver. “Different teams may remove various organs, which may then be transported to different locations,” he said. “It’s not surprising that multiple organ donations have had longer delays.”
Dr. Goldberg said the team’s analysis showed that the initial COVID-19 surge was not the cause of pre-procurement delays, especially since testing soon became routine on admission.
For the study, Miller School researchers used data from the Organ Procurement and Transplant Network on post-donation from brain-dead donors between April 7, 2019, and June 30, 2020. These included 6,230 pre-acute liver donors and 10,749 new policy implementations. Median pre-purchase time increased from 47.6 hours to 50.3 hours, with rounded vision.
“While pre-procurement times increased by 2 to 4 hours on average, there was an outlier increase of 48 hours or more in most regions,” Dr. Goldberg said. “Future research is needed to better understand the impact of pre-procurement delays on families, ICU stress, and the financial consequences of donating hospitals.”
Radha Krishnan, R., Wait. (2022) Association of Liver Sensitivity Circle Allocation Policy with U.S. Donor Procurement Timing. Journal of the American Medical Association Surgery. doi.org/10.1001/jamasurg.2022.1058.