TN05 QUALITY ASSESSMENT OF THE ORGAN DONOR RETRIEVAL PROCESS

Organ procurement surgery is a nocturnal pursuit with inherent risk of surgical misadventure. A single deceased donor organ procurement service was established in NSW to simplify retrieval of abdominal organs for transplantation in 17 Australian centres. An Organ Retrieval Report Form (ORRF) was created as a communication tool to facilitate identification of systemic problems. Methods:   The surgical technique was standardised. ORRF were distributed with each kidney, liver, liver lobe and pancreas and returned to a data co-ordinator. Identified problems were collated and reviewed by medical advisors. Fisher's exact test was used. Results:   Compliance with ORRF return was 98%. 662 abdominal organs from 229 donors (10.4% DCD) were transplanted in 4 year period from July 2004. 18 organs were deemed unsuitable for transplantation, with 3 for avoidable reasons. Donor surgeons reported an iatrogenic injury to kidney and liver vessels in 7.4% (n = 13) and 4.4% (n = 5) of donors respectively (p = 0.45). The annual rate of donor surgeon recognition of injury increased with time from 5 to 14% (p = 0.067). Transplanting teams reported problems in an additional 23% of donors. Combining donor and retrieval reported data, structural injury occurred in 12.3% of kidneys, no pancreases (p = 0.008) and 4.8% of livers (p = 0.003). The rate of injury did not improve with time. Conclusions:   The ORRF proved a valuable quality tool. Transplanting centre evaluation served to strengthen of retrieval protocols. The significant disproportion of kidney versus liver donor related injuries, dictated that the senior surgeon remained with the donor until removal of all donor organs rather than retreating to the back table after liver retrieval.