The Public Health Service “Increased Risk” 2020 Policy Change Has not Improved Organ Utilization in the United States: A Nationwide Cohort Study
Objective:. To assess the effects of the 2020 United States Public Health Service (PHS) “Increased Risk” Guidelines update. Background:. Donors labeled as “Increased Risk” for transmission of infectious diseases have been found to have decreased organ utilization rates despite no significant impact...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2024-03-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000368 |
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| author | Dane C. Paneitz, MD, MPH Stanley B. Wolfe, MD, MPH Duc Giao, BA Shannon N. Tessier, PhD Leigh Anne Dageforde, MD, MPH Nahel Elias, MD Seyed Alireza Rabi, MD, PHD Eriberto Michel, MD David A. D’Alessandro, MD Asishana A. Osho, MD, MPH |
| author_facet | Dane C. Paneitz, MD, MPH Stanley B. Wolfe, MD, MPH Duc Giao, BA Shannon N. Tessier, PhD Leigh Anne Dageforde, MD, MPH Nahel Elias, MD Seyed Alireza Rabi, MD, PHD Eriberto Michel, MD David A. D’Alessandro, MD Asishana A. Osho, MD, MPH |
| author_sort | Dane C. Paneitz, MD, MPH |
| collection | DOAJ |
| description | Objective:. To assess the effects of the 2020 United States Public Health Service (PHS) “Increased Risk” Guidelines update.
Background:. Donors labeled as “Increased Risk” for transmission of infectious diseases have been found to have decreased organ utilization rates despite no significant impact on recipient survival. Recently, the PHS provided an updated guideline focused on “Increased Risk” organ donors, which included the removal of the “Increased Risk” label and the elimination of the separate informed consent form, although the actual increased risk status of donors is still ultimately transmitted to transplant physicians. We sought to analyze the effect of this update on organ utilization rates.
Methods:. This was a retrospective analysis of the Organ Procurement and Transplantation Network database which compared donor organ utilization in the 2 years before the June 2020 PHS Guideline update for increased-risk donor organs (June 2018–May 2020) versus the 2 years after the update (August 2020–July 2022). The organ utilization rate for each donor was determined by dividing the number of organs transplanted by the total number of organs available for procurement. Student t test and multivariable logistic regression models were used for analysis.
Results:. There were 17,272 donors in the preupdate cohort and 17,922 donors in the postupdate cohort; of these, 4,977 (28.8%) and 3,893 (21.7%) donors were considered “Increased Risk”, respectively. There was a 2% decrease in overall organ utilization rates after the update, driven by a 3% decrease in liver utilization rates and a 2% decrease in lung utilization rates. After multivariable adjustment, donors in the postupdate cohort had 10% decreased odds of having all organs transplanted.
Conclusions:. The 2020 PHS “Increased Risk” Donor Guideline update was not associated with an increase in organ utilization rates in the first 2 years after its implementation, despite a decrease in the proportion of donors considered to be at higher risk. Further efforts to educate the community on the safe usage of high-risk organs are needed and may increase organ utilization. |
| format | Article |
| id | doaj-art-e956b0ac30694a91862851afaea2fbaf |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2024-03-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-e956b0ac30694a91862851afaea2fbaf2025-01-24T09:18:25ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932024-03-0151e36810.1097/AS9.0000000000000368202403000-00003The Public Health Service “Increased Risk” 2020 Policy Change Has not Improved Organ Utilization in the United States: A Nationwide Cohort StudyDane C. Paneitz, MD, MPH0Stanley B. Wolfe, MD, MPH1Duc Giao, BA2Shannon N. Tessier, PhD3Leigh Anne Dageforde, MD, MPH4Nahel Elias, MD5Seyed Alireza Rabi, MD, PHD6Eriberto Michel, MD7David A. D’Alessandro, MD8Asishana A. Osho, MD, MPH9From the * Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MAFrom the * Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MAFrom the * Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA† Department of Surgery, Center for Engineering in Medicine & Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA‡ Division of Abdominal Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.‡ Division of Abdominal Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.From the * Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MAFrom the * Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MAFrom the * Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MAFrom the * Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MAObjective:. To assess the effects of the 2020 United States Public Health Service (PHS) “Increased Risk” Guidelines update. Background:. Donors labeled as “Increased Risk” for transmission of infectious diseases have been found to have decreased organ utilization rates despite no significant impact on recipient survival. Recently, the PHS provided an updated guideline focused on “Increased Risk” organ donors, which included the removal of the “Increased Risk” label and the elimination of the separate informed consent form, although the actual increased risk status of donors is still ultimately transmitted to transplant physicians. We sought to analyze the effect of this update on organ utilization rates. Methods:. This was a retrospective analysis of the Organ Procurement and Transplantation Network database which compared donor organ utilization in the 2 years before the June 2020 PHS Guideline update for increased-risk donor organs (June 2018–May 2020) versus the 2 years after the update (August 2020–July 2022). The organ utilization rate for each donor was determined by dividing the number of organs transplanted by the total number of organs available for procurement. Student t test and multivariable logistic regression models were used for analysis. Results:. There were 17,272 donors in the preupdate cohort and 17,922 donors in the postupdate cohort; of these, 4,977 (28.8%) and 3,893 (21.7%) donors were considered “Increased Risk”, respectively. There was a 2% decrease in overall organ utilization rates after the update, driven by a 3% decrease in liver utilization rates and a 2% decrease in lung utilization rates. After multivariable adjustment, donors in the postupdate cohort had 10% decreased odds of having all organs transplanted. Conclusions:. The 2020 PHS “Increased Risk” Donor Guideline update was not associated with an increase in organ utilization rates in the first 2 years after its implementation, despite a decrease in the proportion of donors considered to be at higher risk. Further efforts to educate the community on the safe usage of high-risk organs are needed and may increase organ utilization.http://journals.lww.com/10.1097/AS9.0000000000000368 |
| spellingShingle | Dane C. Paneitz, MD, MPH Stanley B. Wolfe, MD, MPH Duc Giao, BA Shannon N. Tessier, PhD Leigh Anne Dageforde, MD, MPH Nahel Elias, MD Seyed Alireza Rabi, MD, PHD Eriberto Michel, MD David A. D’Alessandro, MD Asishana A. Osho, MD, MPH The Public Health Service “Increased Risk” 2020 Policy Change Has not Improved Organ Utilization in the United States: A Nationwide Cohort Study Annals of Surgery Open |
| title | The Public Health Service “Increased Risk” 2020 Policy Change Has not Improved Organ Utilization in the United States: A Nationwide Cohort Study |
| title_full | The Public Health Service “Increased Risk” 2020 Policy Change Has not Improved Organ Utilization in the United States: A Nationwide Cohort Study |
| title_fullStr | The Public Health Service “Increased Risk” 2020 Policy Change Has not Improved Organ Utilization in the United States: A Nationwide Cohort Study |
| title_full_unstemmed | The Public Health Service “Increased Risk” 2020 Policy Change Has not Improved Organ Utilization in the United States: A Nationwide Cohort Study |
| title_short | The Public Health Service “Increased Risk” 2020 Policy Change Has not Improved Organ Utilization in the United States: A Nationwide Cohort Study |
| title_sort | public health service increased risk 2020 policy change has not improved organ utilization in the united states a nationwide cohort study |
| url | http://journals.lww.com/10.1097/AS9.0000000000000368 |
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