A mixed-methods approach to identify factors determining utilization of marginal quality deceased donor livers for transplantation

一种混合方法来确定决定使用边际质量死亡供体肝脏进行移植的因素

• 批准号: 10315615
• 负责人: David Coulton Cron
• 金额: $ 7.13万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10315615
• 关键词: Address; Adopted; Adoption; Age; Algorithms; Area; Award; Cardiac Death; Characteristics; Clinical; Complement; Complex; Consensus; Data; Databases; Decision Making; Development; Development Plans; Fellowship; Future; Goals; Improve Access; Intention; Interview; Knowledge; Learning; Liver; Mentors; Methodology; Methods; Modeling; New England; Organ; Organ Donor; Organ Procurements; Organ Transplantation; Outcome; Patients; Pilot Projects; Policy Developments; Process; Qualitative Research; Research; Research Methodology; Risk; Running; Science; Scientist; Services; Source; Structure; Surgeon; Techniques; Time; Training; Transplant Recipients; Transplant Surgeon; Transplantation; Transplantation Surgery; United States; Variant; Wait Time; Waiting Lists; Work; career development; data registry; design; experience; high risk; improved; interest; liver transplantation; novel; post-transplant; transplant centers; transplant database; transplant registry; willingness

Project Summary/Abstract The liver transplant waitlist in the United States exceeds the number of transplants performed by over 3,000 people annually. Despite this shortage, 10% of donor livers are considered “marginal” in quality and discarded annually. Marginal donor livers (MDLs) have higher risk characteristics such as donation after cardiac death (DCD), older age, steatosis, and national sharing. With careful donor-recipient matching, MDLs can be used without compromising patient survival, weighing organ quality risks against the risk of waiting for a “better” organ. MDLs therefore represent an underutilized but valuable source of transplantable livers. Despite a growing amount of evidence showing good outcomes for MDLs, adoption of this practice remains variable across centers. In attempt to explain this, our objective with this project is to examine the process of decision-making for MDL transplantation and to identify areas for process improvement. Our central hypothesis is that use of MDLs varies across transplant centers, even within the same region, and is influenced by donor, recipient, and institutional factors. We propose a mixed-methods approach to identify factors associated with MDL utilization using national transplant registry data and qualitative interviews with New England transplant centers. We will perform a quantitative study of donor-recipient organ offers using a novel database of allocation match run results to identify donor and recipient factors influencing a surgeon or center’s decision to accept an MDL for transplant. Next, to elucidate key steps in the decision to transplant an MDL, we will conduct semi-structured interviews with transplant surgeons from New England’s liver transplant centers to identify barriers and facilitators to transplanting MDLs, with a focus on surgeon decision-making and structural or systemic influences at the center level. Our proposed research will deconstruct the complex decision-making underlying the decision to transplant an MDL. We expect the results of this study will identify actionable targets for process improvement and policy development. This work will provide a framework for studying transplant center practices and surgeon decision-making. By focusing on New England for the qualitative portion of this proposal, we will show feasibility on a smaller regional level with the intention to later scale our methods and results across other regions, ultimately inciting regionally driven efforts of collaborative process improvement. The knowledge acquired from this work has the potential to increase access to liver transplantation by optimizing use of available organs. By performing this work, Dr. Cron will receive mentored training in qualitative methodology and clinical transplantation science, facilitating his development into an independent surgeon-scientist and a leader in transplant surgery.

项目概要/摘要 美国肝移植等待名单超过3000例移植手术 人每年。尽管存在短缺，但仍有 10% 的供体肝脏被认为质量“边缘”并被丢弃 每年。边缘供肝（MDL）具有较高的风险特征，例如心源性死亡后的捐献 （DCD）、老年、脂肪变性和全国共享。通过仔细的供体-受体匹配，可以使用 MDL 在不影响患者生存的情况下，权衡器官质量风险与等待“更好”的风险 器官。因此，MDL 代表了一种未得到充分利用但有价值的可移植肝脏来源。 尽管越来越多的证据表明 MDL 取得了良好的效果，但这种做法仍然被采用 跨中心可变。为了解释这一点，我们这个项目的目标是检查 MDL 移植的决策并确定流程改进的领域。我们的中心假设 不同移植中心甚至同一地区的 MDL 的使用情况各不相同，并且受到捐赠者的影响， 接受者和制度因素。我们提出了一种混合方法来识别与 使用国家移植登记数据和新英格兰移植定性访谈的 MDL 利用率 中心。我们将使用一个新颖的数据库对捐赠者和接受者的器官报价进行定量研究 分配匹配运行结果，以确定影响外科医生或中心决定的捐赠者和接受者因素 接受移植 MDL。接下来，为了阐明移植 MDL 决策的关键步骤，我们将 对新英格兰肝移植中心的移植外科医生进行半结构化访谈 确定移植 MDL 的障碍和促进因素，重点是外科医生的决策和结构 或中央层面的系统性影响。 我们提出的研究将解构移植决策背后的复杂决策 MDL。我们预计这项研究的结果将确定流程改进和政策的可行目标 发展。这项工作将为研究移植中心实践和外科医生提供一个框架 决策。通过关注新英格兰这个提案的定性部分，我们将展示 在较小的区域层面上进行可行性研究，以便以后将我们的方法和结果扩展到其他地区 区域，最终激发区域驱动的协作流程改进努力。 从这项工作中获得的知识有可能通过以下方式增加肝移植的机会： 优化可用器官的使用。通过执行这项工作，Cron 博士将接受以下领域的指导培训： 定性方法论和临床移植科学，促进他发展成为独立的 外科医生科学家和移植手术的领导者。