Estimating the Potential Pool of Uncontrolled DCD Donors in the United States

Brian J. Boyarsky; Kyle R. Jackson; Amber B. Kernodle; Joseph V. Sakran; Jacqueline M. Garonzik-Wang; Dorry L. Segev; Shane E. Ottmann

Disclosures

American Journal of Transplantation. 2020;20(10):2842-2846. 

In This Article

Methods

Data Source

We evaluated registry data from the NEDS between January 1, 2013 and December 31, 2016. The NEDS is the largest all-payer ED database in the United States, yielding national estimates of hospital-based ED visits. Weighted, it estimates roughly 143 million ED visits per year. NEDS was developed through a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality (Table 1).

Study Population

We used single-level Clinical Classification Software (CCS) coding algorithms based on International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9-CM; ICD-10-CM) to identify our population of interest. In order to be included in the analysis, the patient's disposition from the ED had to be recorded as death. Only patients ≤55 years old were included. We excluded patients based on medical contraindications to donation (any evidence of infection, cardiopulmonary disease, hematologic/oncologic disease, metabolic disorders or derangements, and gastrointestinal comorbidities) and generally accepted contraindications to uDCD (including hemorrhage or vascular catastrophe, major polytrauma, burns, and poisoning).[22] We also excluded patients with diagnosis or procedure codes for organ procurement. We then divided causes of death into traumatic and medical. Traumatic death causes included head trauma, other penetrating or blunt injury; and medical causes included stroke, anoxia, or seizure.

Statistical Analysis

Nationwide estimates were generated by taking into account the stratified cluster sampling utilized by NEDS. Data were analyzed using singly scaled SVY (survey) commands in Stata 16.0/MP (Stata Corp. LP). Average estimates with ranges were determined for all categories of potential uDCD. Strata with a single sampling unit were reassigned to alternative strata based on hospital geographic region and size.

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