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A 360° Rotational Positioning Protocol of Organ Donors May Increase Lungs Available for Transplantation*

Mendez, Marissa A. MD1; Fesmire, Alyssa J. MD1; Johnson, Scott S. MD2; Neel, Dustin R. MD, FACS1; Markham, Lori E. RN, MSN, CCRN, CPTC, CTBS3; Olson, Jody C. MD, FACP4; Ott, Melissa NP-C, CPTC3; Sangha, Harbaksh MD, MBA5; Vasquez, Donald G. DO, MPH, FACOS6; Whitt, Stevan P. MD, FACP7; Wilkins, Harry E. III MD, MHCM, FACS3; Moncure, Michael MD, FACS1

doi: 10.1097/CCM.0000000000003805
Clinical Investigations

Objectives: To evaluate the improvement in lung donation and immediate lung function after the implementation of a 360° rotational positioning protocol within an organ procurement organization in the Midwest.

Design: Retrospective observational study.

Setting: The Midwest Transplant Network from 2005 to 2017. Rotational positioning of donors began in 2008.

Subjects: Potential deceased lung donors.

Interventions: A 360° rotational protocol. Presence of immediate lung function in recipients, change in Pao2:Fio2 ratio during donor management, initial and final Pao2:Fio2 ratio, and proportion of lungs donated were measured. Outcomes were compared between rotated and nonrotated donors.

Measurements and Main Results: A total of 693 donors were analyzed. The proportion of lung donations increased by 10%. The difference between initial Pao2:Fio2 ratio and final Pao2:Fio2 ratio was significantly different between rotated and nonrotated donors (36 ± 116 vs 104 ± 148; p < 0.001). Lungs transplanted from rotated donors had better immediate function than those from nonrotated donors (99.5% vs 68%; p < 0.001).

Conclusions: There was a statistically significant increase in lung donations after implementing rotational positioning of deceased donors. Rotational positioning significantly increased the average difference in Pao2:Fio2 ratios. There was also superior lung function in the rotated group. The authors recommend that organ procurement organizations consider adopting a rotational positioning protocol for donors to increase the lungs available for transplantation.

1Department of Surgery, Truman Medical Center, University of Missouri Kansas City, Kansas City, MO.

2Via Christi St. Francis, Wichita, KS.

3Midwest Transplant Network, Mission, KS.

4University of Kansas Medical Center, Kansas City, MO.

5Lake Regional Health System, Osage Beach, MO.

6Wesley Medical Center, Wichita, KS.

7University of Missouri Health Care, Columbia, MO.

*See also p. 1154.

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University of Missouri Kansas City and Midwest Transplant Network are sponsoring institutions.

Dr. Whitt received funding from Midwest Transplant Network. Dr. Wilkins disclosed that he is the administrative Medical Director for, and is also a member of, Midwest Transplant Network. The remaining authors have disclosed that they do not have any potential conflicts of interest

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