To understand the association between 2 transplant center (TXC) organizational characteristics, volume and closeness centrality, with total ischemic time for deceased donor lung transplants in conjunction with the removal of donation service area (DSA) lung allocation policy.
The organization of donor procurements has received increased attention since DSA was removed from allocation policy. Consistent with network theories of organization, a TXC’s organizational characteristics could affect procurement efficiency, as volume and closeness centrality (measuring how connected a TXC is within the OPTN) could be associated with total ischemic time. These associations could have changed because of the removal of DSA from allocation policy.
We conducted a retrospective, pooled cross-sectional study of total ischemic time for nonperfused deceased donor lung transplants (n=9281) between 2015 and 2019, employing Within-Between regression.
Higher volume TXCs exhibited lower total ischemic times after the removal of DSA from lung allocation policy (p=.011); however, all TXCs that had increased volumes, after the removal of DSA from lung allocation policy, exhibited higher levels of total ischemic time (p=<.001). Prior the removal of DSA, TXCs that increased volumes exhibited lower levels of ischemic time (p=<.001). Both within and between closeness centrality exhibited u-shaped associations with total ischemic time (p=.012; p=.006) and the effect of closeness centrality on total ischemic time was different after DSA removal (p<.001).
Organizational characteristics were associated with the efficiency of deceased organ procurements. The effects on total ischemic time were dependent on whether DSA was utilized for lung allocation.