Multi-centric study on organ donation after trauma: A cluster analysis

Abstract text (incl. references and figure legends)

Introduction: The critical gap between organs available for transplantation and patients on waiting lists calls for the need to identify ways to increase the donor pool1-4. The primary aim of this study is to characterize subtypes of trauma donors and examine a relationship between damage control strategies and organ donatios. Materials and Method: The revision of data from three major hospitals in Northern Italy was assessed: Niguarda in Milan, Papa Giovanni XXIII in Bergamo, and Ospedale Maggiore Policlinico in Milan. Data search identified deceased organ donors whose cause of death was major trauma, from January 2012 to September 2021. A cluster analysis algorithm was used to group patients. Results: Two main clusters were identified, which significantly differ in age (29.39 ± 18.87 vs. 61.26 ± 14.36, p<0.001), injury severity score (42.93 ± 17.38 vs. 34.19 ± 13.27, p=0.002) and in the total number of Damage Control Strategies (DCS) applied (4.31 ± 2.54 vs. 1.98 ± 1.54, p<0.001). With regards to solid organ donation, Cluster 1 donated more organs per donor than Cluster 2 (4.5 ± 1.62 vs. 3.59 ± 1.43, p=0.001) and, in particular, produced significantly more hearts (65% vs. 34%, p=0.001). The functional response rate, defined as the proportion of organs that did not have primary dysfunction in the first 30-days, was equal (93% vs. 93%, p=0.929). Conclusion: Aggressive DCS does not negatively impact the possibility of organ donation from severely injured patients but rather contributes to the production of a significant number of organs for transplantation with comparable functional outcomes. References: 1.Ackerman A, Organ donation after trauma: A 30-year review. J Trauma Acute Care Surg. 2019; 2.Altomare M, Organ Donation after Damage Control Strategy in Trauma Patients: Experience from First Level Trauma Center in Italy. Life. 2022; Peetz AB, Regional ethics of surgeon resuscitation for organ transplantation after lethal injury. Surgery. 2021.

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