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Organ Procurement Organization Survey of Practices and Beliefs Regarding Prerecovery Percutaneous Liver Biopsy in Donation After Neurologic Determination of Death

Oliver, Joseph Benton MD, MPH; Marcus, Andrea Fleisch PhD, MPH; Paster, Mark; Nespral, Joseph BSN; Bongu, Advaith MD; Dikdan, George PhD; Brown, Lloyd MD, MS; Neidlinger, Nikole MD; Koneru, Baburao MD, MPH

doi: 10.1097/TP.0000000000001632
Original Clinical Science—Liver

Background Prerecovery liver biopsy (PLB) allows histological evaluation of the organ before procurement. The opinions and what factors might influence PLB use within Organ Procurement Organizations (OPOs) are unknown.

Methods A survey instrument was distributed by the Association of OPOs to the clinical directors of all 58 OPOs. Descriptive statistics were calculated. Results were also stratified based on OPO characteristics.

Results Forty-nine (84.5%) of 58 OPOs responded to the survey; 40 (81.6%) of 49 currently perform PLB. This did not vary based on land mass, population, livers discarded, transplanted, donor age, or recipient MELD scores. Donor age, obesity, alcohol abuse, hepatitis serology, liver only donor, imaging results, and transplant center request were the most common indications for PLB in over 80% of OPOs. The median rate of performance is 5% to 10% of donors. Most use interventional radiologists to perform and the donor hospital pathologist/s to interpret PLB. Most OPOs believe PLBs are safe, reliable, useful, and performed often enough. Most say they did not believe they are easy to obtain. Beliefs were mixed regarding accuracy. The topics likely to influence PLB use were utility and accuracy of PLB, and availability of staff to perform PLB. OPOs that perform PLB more often were more likely to have favorable opinions of safety and pathologist availability, and more influenced by safety, reliability, availability, and a national consensus on the use of PLB.

Conclusions Considerable variability exists in the use of PLB. Additional information on the utility, accuracy, and safety of PLB are needed to optimize its use.

This work collected data from 49 organ procurement organizations regarding the use of prerecovery liver biopsies in potential organ donors and finds that there is wide variability regarding indications and logistics. The more difficult questions of whether these biopsies enable more donations and their predictive accuracy require further study. Supplemental digital content is available in the text.

1 Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ.

2 Rutgers-School of Health Related Professions, Newark, NJ.

3 Association of Organ Procurement Organizations, Vienna, VA.

4 Texas Organ Sharing Alliance, San Antonio, TX.

Received 21 July 2016. Revision received 29 November 2016.

Accepted 11 December 2016.

The data in this article was presented as a poster presentation at the 2015 American Society of Transplant Surgeon’s Winter Symposium in Miami, Florida with a subsequent abstract published in a supplement to the American Journal of Transplantation.

The authors declare no funding or conflicts of interest.

J.B.O. participated in the concept and design, analysis and interpretation of data, drafting and revision of manuscript. A.F.M. participated in the design, analysis and interpretation of data, revision of article. M.P. participated in the design, acquisition of data, and revision of the article. J.N. participated in the design, acquisition of data, and revision of the article. A.B. participated in the concept and design, interpretation of data, and revision of the article. G.D. participated in the concept and design and revision of the article. L.B. participated in the concept and design, interpretation of data, and revision of the article. N.N. participated in the acquisition of data and revision of the article. B.K. participated in the concept and design, analysis and interpretation of data, drafting and revision of the article.

Correspondence: Baburao Koneru, MD, MPH, 185 South Orange Ave MSB G-506 Newark, NJ 07101-1709. (koneruba@njms.rutgers.edu).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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