Utilizing a Multidisciplinary Approach to Improve Successful Pediatric Lung Procurement in a Pediatric Intensive Care Unit

Abstract

Background: Organ procurement and transplant is an integral part of a Pediatric Intensive Care Unit (PICU). As of March 2019, 33 children are waiting to receive a lifesaving lung transplant in the United States1. The longer these children remain on waitlists, the less likely they are to have good survival rates after transplant2. From 2015-2017 our lung procurement rate for consenting pediatric donors (n = 18) was 0%. We aimed to increase the lung procurement rate in our PICU using a continuous improvement model. Methods: A multi-disciplinary team was developed and led by the PICU medical director. The team included physicians, nurses, donation agency staff, social work, and respiratory therapists. The team met quarterly to review all possible organ donation cases and assess them utilizing a continuous improvement model. Learnings from this meeting were then disseminated to bedside caregivers on an ongoing basis. Based on these learnings, the PICU team was able to implement changes to aid in improving lung procurement success. Early identification of lung donor candidates was integral to program success. The screening was done via bedside chest x-ray and bronchoscopy. A bronchial alveolar lavage and sputum culture were obtained. An oxygen challenge was considered every 4 hours. Candidates then received airway clearance every 2 to 4 hours until procurement. Results: By utilizing an interdisciplinary team approach and a model of continuous improvement, we were able to increase lung procurement rates by 16% (n = 6). We also increased the number of organs transplanted per donor from 3.62 to 4.0 organs per donor. Conclusions: By utilizing an interdisciplinary team and continuous improvement approach, our PICU was able to increase lung procurement rates for our pediatric donors. In our analysis, we also determined that an overall increase in organs donated occurred after we completed our continuous improvement process. A standard protocol for assessment and treatment until procurement is vital in maintaining organ viability for procurement. Increasing the number of successful organs procured per donor means the gift of donation potentially saves more lives. We recommend that all cases of possible organ donation be reviewed in order to be better stewards of organs procured after death. References: 1. UNOS optn.transplant.hrsa.gov/data 2. Lauerer M et al. Organ transplant in the face of donor shortage. Visc Med 2016;32(4):278-285.