Reexamining Risk Aversion: Willingness to Pursue and Utilize Nonideal Donor Livers Among US Donation Service Areas.
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2021-09
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Abstract
Background
Livers from "nonideal" but acceptable donors are underutilized; however, organ procurement organization (OPO) metrics do not assess how OPO-specific practices contribute to these trends. In this analysis, we evaluated nonideal liver donor avoidance or risk aversion among OPOs and within US donation service areas (DSAs).Methods
Adult donors in the United Network for Organ Sharing registry who donated ≥1 organ for transplantation between 2007 and 2019 were included. Nonideal donors were defined by any of the following: age > 70, hepatitis C seropositive, body mass index > 40, donation after circulatory death, or history of malignancy. OPO-specific performance was evaluated based on rates of nonideal donor pursuit and consent attainment. DSA performance (OPO + transplant centers) was evaluated based on rates of nonideal donor pursuit, consent attainment, liver recovery, and transplantation. Lower rates were considered to represent increased donor avoidance or increased risk aversion.Results
Of 97 911 donors, 31 799 (32.5%) were nonideal. Unadjusted OPO-level rates of nonideal donor pursuit ranged from 88% to 100%. In a 5-tier system of overall risk aversion, tier 5 DSAs (least risk-averse) and tier 1 DSAs (most risk-averse) had the highest and lowest respective rates of non-ideal donor pursuit, consent attainment, liver recovery, and transplantation. On average, recovery rates were over 25% higher among tier 5 versus tier 1 DSAs. If tier 1 DSAs had achieved the same average liver recovery rate as tier 5 DSAs, approximately 2100 additional livers could have been recovered during the study period.Conclusion
Most OPOs aggressively pursue nonideal liver donors; however, recovery practices vary widely among DSAs. Fair OPO evaluations should consider early donation process stages to best disentangle OPO and center-level practices.Type
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Halpern, Samantha E, Mariya L Samoylova, Brian I Shaw, Samuel J Kesseli, Matthew G Hartwig, Yuval A Patel, Lisa M McElroy, Andrew S Barbas, et al. (2021). Reexamining Risk Aversion: Willingness to Pursue and Utilize Nonideal Donor Livers Among US Donation Service Areas. Transplantation direct, 7(9). p. e742. 10.1097/txd.0000000000001173 Retrieved from https://hdl.handle.net/10161/33506.
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Scholars@Duke
Samuel Kesseli
Matthew Hartwig
Dr. Hartwig is a thoracic surgeon with a clinical focus in lung transplantation and robotic assisted minimally invasive thoracic surgery for the treatment of diseases of the chest. He serves as the Surgical Director of the Duke Lung Transplant Program and the Esophageal Center at Duke. Additionally, he directs the Surgical Office of Clinical Research, which manages the clinical research portfolio for the Department of Surgery. He also leads a successful program of clinical, basic and translational research in thoracic surgery and lung transplantation. He currently directs the Duke Ex Vivo Organ Laboratory (DEVOL), is the Chief of Lung Transplant Research, and is a faculty member at the Duke Clinical Research Institute (DCRI).
Dr. Hartwig has over 150 peer reviewed publications, received numerous awards, chaired many sessions at national and international meetings, serves regularly on NIH study sections, and is on the editorial board of many prominent journals. He has also personally mentored over pre-and post-doctoral trainees, many of whom are now engaged in their own successful research careers.
Lisa M McElroy
I am an abdominal transplant surgeon with a health services research lab focused on understanding how complex health care processes and large multidisciplinary teams affect outcomes of high cost, high acuity patients. I have a master's degree in health services and outcomes research methodology with supplemental training in health disparities research methods, engineering methods for healthcare system and process assessment, organizational behavior theory and change management, and implementation science.
As my research has progressed, an emerging theme has been the interplay between biologic and social risk, which each contribute to a patient’s ultimate success but receive disproportionate consideration in anticipation of and in response to subpar outcomes. I am currently involved in several efforts that build on this concept and employ an approach to health equity research that accounts for center and organizational-level characteristics when examining differences in care based on social determinants of health.
Andrew Serghios Barbas
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