The effect of a protocol of aggressive donor management: Implications for the national organ donor shortage

J Trauma. 2006 Aug;61(2):429-33; discussion 433-5. doi: 10.1097/01.ta.0000228968.63652.c1.


Background: The disparity between the number of people awaiting organ transplantation and the number of organs available has become a public health crisis. As many as 25% of potential donors are lost as a result of cardiovascular collapse (CVC) before organ harvest. A policy of aggressive donor management (ADM) may decrease the number of cadaveric donors lost as a result of CVC.

Methods: Retrospective analysis of potential brain-dead donors evaluated from January 1995 to December 2003 at nine American College of Surgeons-verified Level I trauma centers covered by a regional organ procurement agency. One center (Los Angeles County + University of Southern California Medical Center [LAC]) had an ADM protocol in place instituted January 1999; the remaining eight centers with no ADM protocol were grouped as Center A. The incidence of CVC and organ donation demographics were compared between centers and within LAC before (LAC-Pre) and after (LAC-Post) adoption of ADM. ADM consists of early identification of potential organ donors, a dedicated team that provides medical management, and aggressive fluid resuscitation as well as hormone replacement therapy with solumedrol and thyroxin.

Results: The incidence of CVC was significantly higher in LAC-Pre (odds ratio [OR] 15.0, p < 0.001) and Center A (OR 5.8, p < 0.001) compared with LAC-Post. The number of organs harvested per potential donor for LAC-Post (2.4) was significantly higher than LAC-Pre (2.0, p = 0.02) and Center A (2.1, p < 0.01).

Conclusion: An aggressive donor management protocol decreases the number of donors lost as a result of cardiovascular collapse and increases the number of harvested organs per potential donor.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Analysis of Variance
  • Brain Death*
  • California
  • Clinical Protocols*
  • Female
  • Humans
  • Male
  • Retrospective Studies
  • Tissue Donors / supply & distribution*
  • Tissue and Organ Harvesting* / statistics & numerical data
  • Tissue and Organ Procurement* / organization & administration
  • Tissue and Organ Procurement* / statistics & numerical data
  • Trauma Centers