OPTN/SRTR 2015 Annual Data Report: Deceased Organ Donation

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1 OPTN/SRTR 2015 Annual Data Report: Deceased Organ Donation A. K. Israni 1,2,3, D. Zaun 1, C. Bolch 1, J.D. Rosendale 4,5, C. Schaffhausen 3, J. J. Snyder 1,2, and B. L. Kasiske 1,3 1 Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN 2 Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 3 Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN 4 Organ Procurement and Transplantation Network, Richmond, VA 5 United Network for Organ Sharing, Richmond, VA Abstract SRTR uses data collected by OPTN to calculate metrics such as donation/conversion rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2015, 1,072,828 death and imminent death referrals were made to Organ Procurement Organizations, of which 21,559 met the definition of eligible (9793) or imminent (11,766) deaths per OPTN policy. The number of deceased donors was 9080, and this number has been increasing since The number of organs authorized for recovery increased slightly to 65,086 in 2015, and the number recovered increased slightly to 25,762. In 2015, 4370 organs were discarded, including 3157 kidneys, 311 pancreata, 703 livers, 30 hearts, and 214 lungs. These numbers suggest a need to reduce the number of organs discarded. 1 Introduction This chapter reports data collected by the Organ Procurement and Transplantation Network (OPTN) to describe metrics such as donation/conversion rate, organ yield, and rate of organs recovered for transplant but not transplanted. 1

2 1.1 Definitions of Terms Related to Deceased Organ Donation ˆ ˆ ˆ Referrals: All deaths and imminent deaths that were reported to the organ procurement organization. Eligible death: As per OPTN policy, death of a person aged 70 years or younger who is legally declared brain dead according to hospital policy and does not exhibit any of the following indications: tuberculosis, human immunodeficiency virus (HIV) infection with specified conditions, Creutzfeldt-Jacob Disease, herpetic septicemia, rabies, reactive hepatitis B surface antigen, any retrovirus infection, active malignant neoplasms (except primary central nervous system tumors and skin cancers), Hodgkin disease, multiple myeloma, leukemia, miscellaneous carcinomas, aplastic anemia, agranulocytosis, fungal and viral encephalitis, gangrene of bowel, extreme immaturity, or positive serological or viral culture findings for HIV. Donor: A person from whom at least one organ was procured for the purpose of transplant, regardless of whether the organ was transplanted. ˆ Eligible donor: A donor whose death met the definition of eligible death. ˆ Organs authorized for recovery: Consent requested and given for recovery of specific organs from a donor. ˆ Donation/conversion rate: Number of eligible donors per 100 eligible deaths. ˆ ˆ ˆ ˆ ˆ ˆ Organ-specific donation/conversion rate: Number of donors of each organ type who met eligibility criteria per 100 eligible deaths. Organs recovered per donor (ORPD): Total number of organs recovered divided by the number of donors, not limited to eligible deaths. Organs transplanted per donor (OTPD): Total number of organs transplanted divided by the number of donors, not limited to eligible deaths. Organ yield metric: Ratio of observed to expected numbers of organs transplanted; expected numbers based on national experience with similar donors. Rate of organs recovered for transplant but not transplanted: Calculated by dividing the number of organs recovered for the purpose of transplant but not transplanted by the number of organs recovered for the purpose of transplant. Expanded criteria donors (ECD): Donors aged 60 years or older, or aged years with two of the following: hypertension, terminal creatinine greater than 1.5 mg/dl, or death from cerebrovascular accident. This definition was developed by OPTN for kidney donors but has been used to classify donors in general. 2

3 2 Eligible Deaths In 2015, 1,072,828 death and imminent death referrals were made to organ procurement organizations, of which 21,559 met the definition of eligible (9793) or imminent (11,766) deaths per OPTN policy. The number of deceased donors was 9080, and this number has been increasing since The number of deceased donor transplants increased to 24,980. This is in contrast to the 5989 living donor transplants in 2015 (Figure DOD 2). The number of organs authorized for recovery increased slightly to 65,086 in 2015, and the number recovered and transplanted increased to 25,762 organs (Figure DOD 3). 3 Donation or Conversion Rate The OPTN requires that organ procurement organizations (OPOs) report all eligible deaths. However, any performance metric based solely on eligible deaths uses only a subset of potential donors, since successful donations can come from donors not meeting the eligible death definition, e.g., donations after cardiac death or donors aged older than 70 years. Recognizing this limitation, the SRTR s current donation/conversion rate is a measure of how often an eligible death becomes a donor. In 2015, the donation/conversation rate was 72.2 eligible donors per 100 eligible deaths, a slight decrease from 73.4 in Unadjusted donation or conversion rates varied by donation service area (DSA), ranging from 59.3 to 89.3 (Figure DOD 4). The conversation rate varied by organ. The highest rate was 66.3 eligible donors per 100 eligible deaths for kidneys, for 6489 kidney donors from 9793 eligible deaths. The lowest conversion rate was 12.4 for pancreas donors, with 1215 donors (Figure DOD 5). 4 Organs Recovered per Donor In 2015, this number was 3.51, slightly higher than 3.50 in 2014 and lower than 3.55 in 2013 (Figure DOD 6). The ORPD for each organ has been stable compared to 2014 (Figure DOD 6, Figure DOD 7). In 2015, the ORPD varied substantially by DSA, ranging from 2.89 to 4.12 (Figure DOD 8, Figure DOD 15). The ORPD is an unadjusted number and thus represents a mix of donor types, including standard criteria donors (SCDs), ECDs, and donation after circulatory death (DCD). The ORPD for kidneys varied from 1.57 to 1.96; for pancreata, from 0.02 to 0.35; for livers, from 0.58 to 0.95; for intestines, from 0.0 to 0.09; for hearts, from 0.07 to 0.44; and for lungs, from 0.12 to 0.69 (Figure DOD 9, Figure DOD 10, Figure DOD 11, Figure DOD 12, Figure DOD 13, Figure DOD 14). 5 Organs Transplanted per Donor and Organ Yield The mean number of OTPD was 3.03 in 2015, similar to 2014 and slightly lower than 3.08 in 2013 (Figure DOD 16). The OTPD for each organ was stable compared to 2014 (Figure DOD 16, Figure DOD 17). In a 2015 unadjusted analysis, not accounting for the mix of SCD, ECD, and DCD donor types, the OTPD varied substantially by DSA, ranging from 3

4 2.46 to 3.71 (Figure DOD 18, Figure DOD 25). The OTPD for kidneys varied from 1.20 to 1.76; for pancreata, from 0.02 to 0.24; for livers, from 0.56 to 0.93; for intestines, from 0.0 to 0.07; for hearts, from 0.05 to 0.44; and for lungs, from 0.12 to 0.63 (Figure DOD 19, Figure DOD 20, Figure DOD 21, Figure DOD 22, Figure DOD 23, Figure DOD 24). The OTPD from donation after brain death (DBD) was 3.25 in 2015, slightly higher than 3.22 in 2014, and slightly lower than 3.29 in The OTPD from DCD donors was 1.93 in 2015, slightly lower than 1.97 in 2014 and slightly higher than 1.88 in 2013 (Figure DOD 26). In 2015, of the 9080 donors, 16% nationally were DCD donors, slightly higher than 15% in The average numbers of kidneys transplanted per donor were 1.44 for DBD (10,921 kidneys) and 1.56 for DCD (2332 kidneys) donors in 2015 (Figure DOD 27). The average number of kidneys transplanted varied by kidney donor profile index (KDPI), and was 1.94, 1.83, 1.55, and 0.60 for KDPI below 0.20, , , and above 0.85, respectively (Figure DOD 33). Comparing the OTPD from DBD versus DCD donors shows that, apart from kidney donors, the OTPD was higher from DBD than from DCD donors (Figure DOD 28, Figure DOD 29, Figure DOD 30, Figure DOD 31, Figure DOD 32). The OTPD for kidneys has been higher from DCD than from DBD donors since 2006 (Figure DOD 27). The number of DCD liver donors continued to increase from 184 in 2004 to 405 in The yield metric shown compares the number of organs transplanted (observed) in with the number of organs that would be expected to be transplanted in based on the national experience with similar donors (expected). A ratio, expressed as observed/expected organs transplanted, of less than 1 indicates that fewer organs were transplanted than would be expected based on the national models for that organ. A ratio of greater than 1 indicates that more organs were transplanted than would be expected. The mean observed/expected ratio for all organs varied from 0.89 to The mean observed/expected ratio for kidneys varied from 0.85 to 1.18; for pancreata, from 0.38 to 2.73; for livers, from 0.84 to 1.20; for intestines, from 0.0 to 4.10; for hearts, from 0.66 to 1.32; and for lungs, from 0.45 to 1.41 (Figure DOD 34, Figure DOD 35, Figure DOD 36, Figure DOD 37, Figure DOD 38, Figure DOD 39). 6 Rate of Organs Recovered for Transplant but Not Transplanted The number of organs recovered for transplant but not transplanted is calculated by subtracting the number of organs transplanted from the number of organs recovered for the purpose of transplant. The rate of organs not transplanted is then calculated by dividing the number of organs not transplanted by the number of organs recovered for the purpose of transplant. The rate in 2015 for all organs combined was 0.14 per recovered organ, slightly higher than 0.13 in 2014 and in 2013 (Figure DOD 40). In 2015, 4370 organs were discarded, including 3157 kidneys, 311 pancreata, 703 livers, 17 intestines, 30 hearts, and 214 lungs (Figure DOD 40). Use of DCD organs for kidney and liver transplant also varied (Figure DOD 41). The proportion of DCD donor organs among deceased donor kidney transplant recipients varied 4

5 across DSAs from 0.01 to At twelve DSAs, less than 10% of kidneys were from DCD donors. Similarly, the proportion of DCD donor organs among deceased donor liver transplant recipients varied across DSAs from 0 to 0.23 (Figure DOD 42). Four DSAs had no livers from DCD donors. The percentage of donors with KDPI greater than 0.85 also varied across the DSAs, ranging from 0 to 14.6 (Figure DOD 43). The DSAs with higher percentages of donors with KPDI greater than 0.85 were not always the same DSAs that had more DCD kidneys. In addition to high-kdpi kidneys, other higher risk kidneys are those with increased risk of infectious disease transmission. The Centers for Disease Control and Prevention (CDC) stipulates standard criteria for donors thought to have a higher risk for infectious disease transmission. Of 2016 CDC high-risk donors in 2015, two kidneys were transplanted from 1291, one kidney from 189, and a liver from These metrics show variation across DSAs in use of DCD donors; the highest number of discards was for kidney (3157). This suggests that sharing best practices between OPOs and their transplant centers could lead to gains in efficiency and organ retrieval, especially for marginal organs such as DCD livers and kidneys and kidneys with KDPI greater than The disposition of donors is described in Figure DOD 44, Figure DOD 45, Figure DOD 46, Figure DOD 47, Figure DOD 48, Figure DOD 49, Figure DOD 50, and Figure DOD 51. 5

6 The publication was produced for the U.S. Department of Health and Human Services, Health Resources and Services Administration, by the Minneapolis Medical Research Foundation (MMRF) and by the United Network for Organ Sharing (UNOS) under contracts HHSH C and C, respectively. This publication lists non-federal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by the U.S. Department of Health and Human Services (HHS) or the Health Resources and Services Administration (HRSA). Neither HHS nor HRSA endorses the products or services of the listed resources. OPTN/SRTR 2015 Annual Data Report is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. Data are not copyrighted and may be used without permission if appropriate citation information is provided. Pursuant to 42 U.S.C. 1320b-10, this publication may not be reproduced, reprinted, or redistributed for a fee without specific written authorization from HHS. Suggested Citations Full citation: Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2015 Annual Data Report. Rockville, MD: Department of Health and Human Services, Health Resources and Services Administration; Abbreviated citation: OPTN/SRTR 2015 Annual Data Report. HHS/HRSA. Publications based on data in this report or supplied on request must include a citation and the following statement: The data and analyses reported in the 2015 Annual Data Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients have been supplied by the United Network for Organ Sharing and the Minneapolis Medical Research Foundation under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. Government. 6

7 In Hospital Deaths (A) Referrals to OPO (B) Eligible Deaths (D) Donors (E) Transplants (F) "True" Potential Donors (C) Figure DOD 1. Relationship between deaths, donations, and transplants. Conceptual schematic (Venn diagram) of actual and potential organ donors. A. Only in rare instances do out-of-hospital deaths result in organ donation. B. Most in-hospital deaths are reported to the local organ procurement organization. C. The number of True Potential Donors (dashed circle) is yet to be defined. D. Eligible Deaths. E. Actual donors, not all of whom result in transplants. F. Deceased donor transplants. OPO, organ procurement organization. Count In Hospital Deaths Eligible Deaths Deceased Donors Deceased Donors Meeting Eligibility Crit Total Transplants Deceased Donor Only Transplants Year Figure DOD 2. Overall counts of eligible deaths, donors, and transplants, The number and source of donors with the number of transplants. 7

8 Count of organs Organs Authorized Organs Transplanted Year Figure DOD 3. Overall counts of authorized and recovered organs, The number of authorized and recovered organs Figure DOD 4. Overall donations per 100 eligible deaths by DSA, Donation rate is the number of deceased donors meeting eligibility criteria per 100 eligible deaths. An eligible death is any hospital-reported death or imminent death that is evaluated and meets organ donor eligibility requirements, with none of the exclusions listed in OPTN policy. 8

9 80 Percent ALL Kidney Pancreas Liver Heart Lung Figure DOD 5. Overall and organ-specific donations per 100 eligible deaths, Organ-specific rates represent the number of donors of each organ type meeting eligibility criteria per 100 eligible deaths All Kidneys Year Figure DOD 6. Organs recovered per donor, all organs and kidney. Average number of overall organs and kidneys recovered per donor, calculated as the sum of recovered organs and by organ type; i.e., up to two kidneys can be recovered from each donor, but only one heart. Pancreata recovered for islet transplant are excluded. 9

10 Pancreas Liver Intestine Heart Lung Year Figure DOD 7. Organs recovered per donor, pancreas, liver, intestine, heart, and lung. Average number of organs other than kidneys recovered per donor, calculated as the sum of recovered organs and by organ type. Pancreata recovered for islet transplant are excluded Figure DOD 8. DSA distribution of all organs recovered per donor, Average number of organs recovered per donor, calculated as the sum of recovered organs and by organ type; i.e., up to two kidneys can be recovered from each donor, but only one heart. DSA-level means are shown. Pancreata recovered for islet transplant are excluded. The vertical line indicates the mean of the DSA-level means. 10

11 Figure DOD 9. DSA distribution of kidneys recovered per donor, Average number of kidneys recovered per donor, calculated as the sum of recovered organs and by organ type. DSA-level means are shown. The vertical line indicates the mean of the DSA-level means Figure DOD 10. DSA distribution of pancreata recovered per donor, Average number of pancreata recovered per donor, calculated as the sum of recovered organs and by organ type. DSA-level means are shown. Pancreata recovered for islet transplant are excluded. The vertical line indicates the mean of the DSA-level means. 11

12 Figure DOD 11. DSA distribution of livers recovered per donor, Average number of livers recovered per donor, calculated as the sum of recovered organs and by organ type. DSA-level means are shown. The vertical line indicates the mean of the DSA-level means Figure DOD 12. DSA distribution of intestines recovered per donor, Average number of intestines recovered per donor, calculated as the sum of recovered organs and by organ type. DSA-level means are shown. The vertical line indicates the mean of the DSA-level means. 12

13 Figure DOD 13. DSA distribution of hearts recovered per donor, Average number of hearts recovered per donor, calculated as the sum of recovered organs and by organ type. DSA-level means are shown. The vertical line indicates the mean of the DSA-level means Figure DOD 14. DSA distribution of lungs recovered per donor, Average number of lungs recovered per donor, calculated as the sum of recovered organs and by organ type. DSA-level means are shown. The vertical line indicates the mean of the DSA-level means. 13

14 Figure DOD 15. Organs recovered per donor by DSA, Average number of organs recovered per donor, calculated as the sum of recovered organs and by organ type; i.e., up to two kidneys can be recovered from each donor, but only one heart. Pancreata recovered for islet transplant are excluded All Kidneys Year Figure DOD 16. Organs transplanted per donor, all organs and kidney. Average number of overall organs and kidneys transplanted per donor. As organs divided into segments (liver, lung, pancreas, intestine) may account for more than one transplant, the number or organs transplanted may exceed the number recovered. Based on a count of recovered organs that are transplanted, which differs from number of transplant operations. DSA-level means are shown. Pancreata recovered for islet transplant are excluded. 14

15 Year Pancreas Liver Intestine Heart Lung Figure DOD 17. Organs transplanted per donor, pancreas, liver, intestine, heart, and lung. Average number of organs other than kidneys transplanted per donor. As organs divided into segments (liver, lung, pancreas, intestine) may account for more than one transplant, the number or organs transplanted may exceed the number recovered. Based on a count of recovered organs that are transplanted, which differs from number of transplant operations. DSA-level means are shown. Pancreata recovered for islet transplant are excluded. 15

16 Figure DOD 18. DSA distribution of all organs transplanted per donor, Average number of organs transplanted per donor. As organs divided into segments (liver, lung, pancreas, intestine) may account for more than one transplant, the number of organs transplanted may exceed the number recovered. Based on a count of recovered organs that are transplanted, which differs from number of transplant operations. DSA-level means are shown. Pancreata recovered for islet transplant are excluded. The vertical line indicates the mean of the DSA-level means. 16

17 Figure DOD 19. DSA distribution of kidneys transplanted per donor, Average number of kidneys transplanted per donor. Based on a count of recovered kidneys that are transplanted, which differs from number of transplant operations. DSA-level means are shown. The vertical line indicates the mean of the DSA-level means Figure DOD 20. DSA distribution of pancreata transplanted per donor, Average number of pancreata transplanted per donor. Pancreata divided into segments may account for more than one transplant, the number of pancreata transplanted may exceed the number recovered. Based on a count of recovered pancreata that are transplanted, which differs from number of transplant operations. DSA-level means are shown. Pancreata recovered for islet transplant are excluded. The vertical line indicates the mean of the DSA-level means. 17

18 Figure DOD 21. DSA distrbution of livers transplanted per donor, Average number of livers transplanted per donor. Livers divided into segments may account for more than one transplant, the number of livers transplanted may exceed the number recovered. Based on a count of recovered livers that are transplanted, which differs from number of transplant operations. DSA-level means are shown. The vertical line indicates the mean of the DSA-level means. 18

19 Figure DOD 22. DSA distribution of intestines transplanted per donor, Average number of intestines transplanted per donor. Intestines divided into segments may account for more than one transplant, the number of intestines transplanted may exceed the number recovered. Based on a count of recovered intestines that are transplanted, which differs from number of transplant operations. DSA-level means are shown. The vertical line indicates the mean of the DSA-level means. 19

20 Figure DOD 23. DSA distrbution of hearts transplanted per donor, Average number of hearts transplanted per donor. Based on a count of recovered hearts that are transplanted, which differs from number of transplant operations. DSA-level means are shown. The vertical line indicates the mean of the DSA-level means Figure DOD 24. DSA distribution of lungs transplanted per donor, Average number of lungs transplanted per donor. Lungs divided into segments may account for more than one transplant, the number of lungs transplanted may exceed the number recovered. Based on a count of recovered lungs that are transplanted, which differs from number of transplant operations. DSA-level means are shown. The vertical line indicates the mean of the DSA-level means. 20

21 Figure DOD 25. Organs transplanted per donor, by DSA, Average number of organs transplanted per donor. As organs divided into segments (liver, lung, pancreas, intestine) may account for more than one transplant, the number or organs transplanted may exceed the number recovered. Based on a count of recovered organs that are transplanted, which differs from number of transplant operations. DSA-level means are shown. Pancreata recovered for islet transplant are excluded. 21

22 DBD DCD Year Figure DOD 26. Organs transplanted per donor, by DBD and DCD status. Average number of organs transplanted per donor. As organs divided into segments (liver, lung, pancreas, intestine) may account for more than one transplant, the number of organs transplanted may exceed the number recovered. Based on a count of recovered organs that are transplanted, which differs from number of transplant operations. DSA-level means are shown. Pancreata recovered for islet transplant are excluded. 22

23 Year DBD DCD Figure DOD 27. Kidneys transplanted per donor, by DBD and DCD status. Average number of kidneys transplanted per donor. Based on a count of recovered kidneys that are transplanted, which differs from number of transplant operations. DSA-level means are shown Year DBD DCD Figure DOD 28. Pancreata transplanted per donor, by DBD and DCD status. Average number of pancreata transplanted per donor. Pancreata divided into segments may account for more than one transplant, the number of pancreata transplanted may exceed the number recovered. Based on a count of recovered pancreata that are transplanted, which differs from number of transplant operations. DSA-level means are shown. Pancreata recovered for islet transplant are excluded. 23

24 DBD DCD Year Figure DOD 29. Livers transplanted per donor, by DBD and DCD status. Average number of livers transplanted per donor. Livers divided into segments may account for more than one transplant, the number of livers transplanted may exceed the number recovered. Based on a count of recovered livers that are transplanted, which differs from number of transplant operations. DSA-level means are shown Year DBD DCD Figure DOD 30. Intestines transplanted per donor, by DBD and DCD status. Average number of intestines transplanted per donor. Intestines divided into segments may account for more than one transplant, the number of intestines transplanted may exceed the number recovered. Based on a count of recovered intestines that are transplanted, which differs from number of transplant operations. DSA-level means are shown. 24

25 DBD DCD Year Figure DOD 31. Hearts transplanted per donor, by DBD and DCD status. Average number of hearts transplanted per donor. Based on a count of recovered hearts that are transplanted, which differs from number of transplant operations. DSA-level means are shown DBD DCD Year Figure DOD 32. Lungs transplanted per donor, by DBD and DCD status. Average number of lungs transplanted per donor. Lungs divided into segments may account for more than one transplant, the number of lungs transplanted may exceed the number recovered. Based on a count of recovered lungs that are transplanted, which differs from number of transplant operations. DSA-level means are shown. 25

26 KDPI 0.20 KDPI KDPI KDPI > Year Figure DOD 33. Kidneys transplanted per donor, by KDPI. Average number of kidneys transplanted per donor. Based on a count of recovered kidneys that are transplanted, which differs from number of transplant operations. KDPI, kidney donor profile index. 1.2 Obs/Exp Ratio Number of Donors Figure DOD 34. Observed-to-expected yield per kidney, Donor yield is a measure of organs transplanted per donor. Expected yield is estimated from statistical models that take into account various charasteristics not under the control of OPOs. Kidney transplants are counted separately as zero, one, or two. The circles represent the 58 OPOs. 26

27 3 2.5 Obs/Exp Ratio Number of Donors Figure DOD 35. Observed-to-expected yield per pancreas, Donor yield is a measure of organs transplanted per donor. Expected yield is estimated from statistical models that take into account various charasteristics not under the control of OPOs. The circles represent the 58 OPOs. 1.3 Obs/Exp Ratio Number of Donors Figure DOD 36. Observed-to-expected yield per liver, Donor yield is a measure of organs transplanted per donor. Expected yield is estimated from statistical models that take into account various charasteristics not under the control of OPOs. The circles represent the 58 OPOs. 27

28 5 Obs/Exp Ratio Number of Donors Figure DOD 37. Observed-to-expected yield per intestine, Donor yield is a measure of organs transplanted per donor. Expected yield is estimated from statistical models that take into account various charasteristics not under the control of OPOs. The circles represent the 58 OPOs. Obs/Exp Ratio Number of Donors Figure DOD 38. Observed-to-expected yield per heart, Donor yield is a measure of organs transplanted per donor. Expected yield is estimated from statistical models that take into account various charasteristics not under the control of OPOs. The circles represent the 58 OPOs. 28

29 1.6 Obs/Exp Ratio Number of Donors Figure DOD 39. Observed-to-expected yield per lung, Donor yield is a measure of organs transplanted per donor. Expected yield is estimated from statistical models that take into account various charasteristics not under the control of OPOs. Single-lung and double-lung transplants are both counted as one organ transplant. The circles represent the 58 OPOs Year Total Kidney Pancreas Liver Intestine Heart Lung Figure DOD 40. Organs recovered for transplant and not transplanted. Rates are calculated as the difference between the number of organs recovered and the number of organs transplanted, divided by the number of organs recovered. Pancreata recovered for islet transplant are excluded. 29

30 No data Figure DOD 41. Variation in proportions of DCD kidney donors among deceased donor transplant recipients, by DSA, DCD kidney donors for deceased donor transplant recipients (as defined in Figures DOD ). DCD, donation after circulatory death No data Figure DOD 42. Variation in proportions of DCD liver donors among deceased donor transplant recipients, by DSA, DCD liver donors for deceased donor transplant recipients (as defined in Figures DOD ). DCD, donation after circulatory death. 30

31 No data Figure DOD 43. Variation in percentage of donors with KDPI greater than 85% among deceased donor kidney transplant recipients, by DSA, Percentage of deceased donor transplants within an DSA with KDPI greater than, or equal to, 85%. 31

32 Consent not requested 22 (0.3%) Recovered, not for transplant 78 (0.9%) Recovered for tx but not tx'ed 1445 (16.8%) Consent not obtained 17 (0.2%) Transplanted 6396 (74.2%) Organ not recovered 660 (7.7%) Donor age (12) Emotional (11) Recovered for research (78) Organ transplanted locally (4598) Discarded locally (839) Acute/chronic renal failure (8) Other specify (6) Organ transplanted shared (1798) Shared and discarded (284) Donor quality (1) Submitted for research (322) Other specify (1) Infection (3) Positive hiv (1) Organ trauma (21) Too old on pump (5) Too old on ice (17) Ureteral damage (2) Diseased organ (43) Vascular damage (18) Biopsy findings (502) Positive hepatitis (6) Donor social history (3) Infection (1) Diseased organ (64) Trauma to organ (9) Time constraints (1) Positive hepatitis (10) Poor organ function (248) No recipient located (27) Donor social history (21) Donor medical history (82) Ruled out due to biopsy (1) Anatomical abnormalities (15) Medical examiner restricted (5) Ruled out after evaluation in or (21) Organ refused by all regional program (15) Organ refused by all national program (94) Organ refused by all programs with urgent need (1) Other (45) Figure DOD 44. Organ use chart for reported left kidneys. A summary of the consent, recovered, tranplanted or discarded status for donated left kidneys. The number of left and right kidneys may not equal the total number of donors. 32

33 Consent not requested 22 (0.3%) Recovered, not for transplant 76 (0.9%) Recovered for tx but not tx'ed 1556 (18.1%) Consent not obtained 17 (0.2%) Transplanted 6287 (73.0%) Organ not recovered 660 (7.7%) Donor age (12) Emotional (11) Recovered for research (76) Organ transplanted locally (4301) Discarded locally (944) Acute/chronic renal failure (8) Other specify (6) Organ transplanted shared (1986) Shared and discarded (281) Donor quality (1) Submitted for research (330) Other specify (1) Exported, not transplanted or transplant unknown (1) Infection (4) Positive hiv (1) Organ trauma (22) Too old on pump (6) Too old on ice (15) Ureteral damage (6) Diseased organ (38) Vascular damage (16) Biopsy findings (496) Positive hepatitis (11) Donor social history (5) Infection (1) Diseased organ (63) Trauma to organ (6) Time constraints (1) Positive hepatitis (10) Poor organ function (245) No recipient located (30) Donor social history (22) Surgical damage in or (1) Donor medical history (88) Anatomical abnormalities (10) Medical examiner restricted (5) Ruled out after evaluation in or (21) Organ refused by all regional program (17) Organ refused by all national program (96) Organ refused by all programs with urgent need (1) Other (43) Figure DOD 45. Organ use chart for reported right kidneys. A summary of the consent, recovered, tranplanted or discarded status for donated right kidneys. The number of left and right kidneys may not equal the total number of donors. 33

34 Consent not requested 3 (0.6%) Recovered, not for transplant 24 (5.2%) Recovered for tx but not tx'ed 78 (16.9%) Consent not obtained 9 (1.9%) Transplanted 285 (61.7%) Organ not recovered 63 (13.6%) Acute/chronic renal failure (1) Emotional (4) Recovered for research (24) Organ transplanted locally (142) Discarded locally (30) Donor quality (2) Cultural beliefs (1) Organ transplanted shared (143) Shared and discarded (21) Family conflict (1) Submitted for research (27) Other specify (3) Too old on ice (1) Diseased organ (3) Vascular damage (6) Ureteral damage (2) Biopsy findings (11) Poor organ function (3) Donor medical history (1) Organ not as described (1) Anatomical abnormalities (4) No recipient located list exhausted (30) Other, specify (15) Infection (1) Diseased organ (9) Time constraints (1) Poor organ function (24) No recipient located (1) Donor medical history (9) No local recovery team (1) Ruled out after evaluation in or (4) Organ refused by all regional program (1) Organ refused by all national program (8) Other (4) Figure DOD 46. Organ use chart for reported en bloc kidneys. A summary of the consent, recovered, tranplanted or discarded status for donated en bloc kidneys. The number of en bloc kidneys may not equal the total number of donors. 34

35 Consent not requested 100 (1.1%) Recovered, not for transplant 644 (7.1%) Recovered for tx but not tx'ed 320 (3.5%) Consent not obtained 194 (2.1%) Transplanted 950 (10.5%) Organ not recovered 6872 (75.7%) Donor age (41) Emotional (132) Recovered for research (605) Organ transplanted locally (683) Discarded locally (178) Non heart beating donor (32) Cultural beliefs (3) Recovered for pancreas islet cells (23) Organ transplanted shared (266) Shared and discarded (37) Hx of diabetes mellitus (8) Religious beliefs (3) Recovered pancreas for technical reasons (for dms use only) (16) Islet cells transplanted (1) Submitted for research (96) Donor quality (7) Family conflict (11) Whole pa/pi, processed for islets, not transplanted or transplant unknown (9) Other specify (12) Other specify (45) Organ trauma (7) Too old on ice (12) Vascular damage (7) Biopsy findings (2) Diseased organ (14) Poor organ function (10) Donor medical history (2) Organ not as described (2) Anatomical abnormalities (83) Warm ischemic time too long (5) No recipient located list exhausted (40) Infection (2) Cardiac arrest (54) Vascular damage (2) Biopsy findings (2) Diseased organ (237) Trauma to organ (25) Time constraints (106) Positive hepatitis (153) Donor social history (94) Surgical damage in or (5) Poor organ function (1428) No recipient located (637) Organ refused by all programs with urgent need (21) No local recovery team (1) Replaced/aberrant rha or cha traversing head of pa (7) Donor medical history (915) Ipda sma junction identified within 5mm from rha junction (1) Ruled out due to biopsy (1) Other (972) Po2 < 200 on o2 challenge (1) Medical examiner restricted (17) Other anatomical abnormality (16) Hemodynamically unstable donor (84) Ruled out after evaluation in or (403) Organ refused by all regional program (182) Organ refused by all national program (1506) Figure DOD 47. Organ use chart for pancreas. A summary of the consent, recovered, tranplanted or discarded status for donated pancreas. 35

36 Consent not requested 20 (0.2%) Recovered, not for transplant 365 (4.0%) Recovered for tx but not tx'ed 703 (7.7%) Consent not obtained 54 (0.6%) Transplanted 6714 (73.9%) Organ not recovered 1224 (13.5%) Donor age (2) Emotional (33) Recovered for research (352) Organ transplanted locally (4122) Discarded locally (462) Non heart beating donor (5) Cultural beliefs (2) Recovered only for purpose hepatocytes (13) Organ transplanted shared (2585) Shared and discarded (53) Donor quality (6) Religious beliefs (1) Exported out of U.S., transplanted (7) Submitted for research (188) Other specify (7) Other specify (18) Infection (4) Organ trauma (11) Too old on ice (12) Diseased organ (63) Vascular damage (12) Biopsy findings (257) Positive hepatitis (1) Donor social history (1) Poor organ function (31) Donor medical history (1) Anatomical abnormalities (54) Cardiac arrest (15) Diseased organ (56) Vascular damage (1) Biopsy findings (81) Trauma to organ (12) Time constraints (71) Positive hepatitis (6) Poor organ function (158) No recipient located (70) Donor social history (10) Surgical damage in or (2) Donor medical history (54) No local recovery team (2) Anatomical abnormalities (4) Ruled out due to biopsy (31) Medical examiner restricted (12) Hemodynamically unstable donor (45) Ruled out after evaluation in or (289) Organ refused by all regional program (78) Organ refused by all national program (60) Organ refused by all programs with urgent need (10) Other (157) Figure DOD 48. Organ use chart for liver. A summary of the consent, recovered, tranplanted or discarded status for donated livers. 36

37 Consent not requested 155 (1.7%) Recovered, not for transplant 302 (3.3%) Recovered for tx but not tx'ed 17 (0.2%) Consent not obtained 338 (3.7%) Transplanted 139 (1.5%) Organ not recovered 8127 (89.5%) Donor age (72) Emotional (245) Recovered for research (302) Organ transplanted locally (22) Discarded locally (8) Non heart beating donor (63) Cultural beliefs (3) Organ transplanted shared (117) Shared and discarded (7) Hx of gastro intestinal disease (3) Religious beliefs (3) Submitted for research (2) Donor quality (8) Family conflict (18) Other specify (9) Other specify (69) Vascular damage (1) Poor organ function (3) Donor medical history (1) No recipient located list exhausted (1) Recipient determined to be unsuitable for tx in or (5) Other, specify (6) Infection (11) Cardiac arrest (95) Diseased organ (65) Trauma to organ (30) Time constraints (58) Positive hepatitis (184) Donor social history (80) Poor organ function (1583) No recipient located (1141) Donor medical history (822) Anatomical abnormalities (2) Medical examiner restricted (20) Hemodynamically unstable donor (84) Ruled out after evaluation in or (31) Organ refused by all regional program (40) Organ refused by all national program (2536) Organ refused by all programs with urgent need (29) Other (1316) Figure DOD 49. Organ use chart for intestine. A summary of the consent, recovered, tranplanted or discarded status for donated intestines. 37

38 Consent not requested 129 (1.4%) Recovered, not for transplant 1226 (13.5%) Recovered for tx but not tx'ed 30 (0.3%) Consent not obtained 207 (2.3%) Transplanted 2824 (31.1%) Organ not recovered 4664 (51.4%) Donor age (25) Emotional (147) Recovered for research (660) Organ transplanted locally (1709) Discarded locally (21) Non heart beating donor (70) Cultural beliefs (4) Recovered for heart valves (566) Organ transplanted shared (1108) Shared and discarded (3) Hx of previous cardiac surgery (5) Religious beliefs (2) Exported out of U.S., transplanted (7) Submitted for research (3) Hx of severe cardiac disease (7) Family conflict (8) Sent for heart valves (3) Donor quality (13) Other specify (46) Other specify (9) Infection (1) Diseased organ (1) Biopsy findings (2) Poor organ function (8) Anatomical abnormalities (6) No recipient located list exhausted (1) Recipient determined to be unsuitable for tx in or (1) Other, specify (10) Infection (5) Vascular damage (2) Trauma to organ (9) Cardiac arrest (156) Diseased organ (342) Time constraints (67) Positive hepatitis (187) Donor social history (23) Surgical damage in or (3) Poor organ function (1352) No recipient located (194) No local recovery team (1) Other (918) Donor medical history (607) Anatomical abnormalities (9) Ejection fraction < 50% (201) Po2 < 200 on o2 challenge (1) Medical examiner restricted (62) Hemodynamically unstable donor (78) Ruled out after evaluation in or (140) Organ refused by all regional program (68) Organ refused by all national program (204) Organ refused by all programs with urgent need (35) Figure DOD 50. Organ use chart for heart. A summary of the consent, recovered, tranplanted or discarded status for donated hearts. 38

39 Characteristic N Percent N Percent Age <18 years % % years % 10, % years % % years % % 65 years % % Sex Female 10, % 11, % Male 15, % 18, % Race/ethnicity White 17, % 19, % Black % % Hispanic % % Other/unkown % % DCD status DBD 24, % 26, % DCD % % Table DOD 1 Characteristics of donors, The donor characteristics of age, sex, race/ethnicity and DCD status in 2005 and

40 Consent not requested 100 (1.1%) Recovered, not for transplant 1308 (14.4%) Recovered for tx but not tx'ed 85 (0.9%) Consent not obtained 202 (2.2%) Transplanted 1933 (21.3%) Organ not recovered 5452 (60.0%) Donor age (23) Emotional (141) Recovered for research (1308) Organ transplanted locally (1085) Discarded locally (36) Non heart beating donor (30) Cultural beliefs (3) Organ transplanted shared (833) Shared and discarded (12) Hx of lung disease (13) Religious beliefs (3) Exported out of U.S., transplanted (15) Submitted for research (36) Donor quality (19) Family conflict (6) Exported, not transplanted or transplant unknown (1) Other specify (15) Other specify (49) Infection (2) Organ trauma (5) Diseased organ (6) Vascular damage (3) Poor organ function (39) Anatomical abnormalities (8) Recipient determined to be unsuitable for tx in or (5) Other, specify (17) Infection (67) + gram stain (9) Cardiac arrest (17) Biopsy findings (1) Diseased organ (328) Trauma to organ (97) Time constraints (173) Positive hepatitis (173) Donor social history (62) Surgical damage in or (4) Poor organ function (2040) No recipient located (241) Other (519) No local recovery team (2) Donor medical history (444) Anatomical abnormalities (5) Po2 < 200 on o2 challenge (447) Medical examiner restricted (57) Hemodynamically unstable donor (79) Ruled out after evaluation in or (247) Organ refused by all regional program (141) Organ refused by all national program (276) Organ refused by all programs with urgent need (23) Figure DOD 51. Organ use chart for lung. A summary of the consent, recovered, tranplanted or discarded status for donated lungs. 40

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