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: 10457283
• 负责人: David Coulton Cron
• 金额: $ 7.44万
• 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/10457283
• 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; Persons; 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.

项目摘要/摘要 美国的肝移植候补表超过了3,000多个移植量 每年的人。尽管短缺，有10％的捐助者生活被认为是“边际”的质量并被丢弃 每年。边缘捐赠者生活（MDLS）具有较高的风险特征，例如心脏死亡后捐赠 （DCD），年龄较大，脂肪变性和国家分享。通过仔细的捐助者匹配，可以使用MDL 没有损害患者的生存，加权器官质量风险与等待“更好”的风险 器官。因此，MDL代表了未充分利用但有价值的移植生活来源。 尽管越来越多的证据显示出MDL的良好结果，但这种做法仍然存在 跨中心变量。为了解释这一点，我们对这个项目的目标是检查 MDL移植的决策和确定过程改进领域。我们的中心假设 MDL的使用在移植中心，即使在同一区域内也有所不同，并且受捐助者的影响， 接受者和机构因素。我们提出了一种混合方法，以识别与 使用国家移植注册表数据和与新英格兰移植的定性访谈的MDL利用率 中心。我们将使用新的数据库对供体 - 恢复器官提供的定量研究进行定量研究 分配匹配运行结果以确定影响外科医生或中心决定的捐助者和接收者因素 接受MDL进行移植。接下来，要阐明决定移植MDL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 确定障碍和促进者以移植MDL，重点是外科医生的决策和结构性 或中心层面的系统影响。 我们拟议的研究将解构移植决定的基本的复杂决策 MDL。我们希望这项研究的结果将确定可行的目标改进和政策的目标 发展。这项工作将为研究移植中心练习和外科医生提供一个框架 决策。通过专注于新英格兰作为本提案的定性部分，我们将展示 在较小的区域层面上的可行性，目的是以后扩展我们的方法和结果 地区，最终煽动了协作过程改进的区域驱动的努力。 从这项工作中获取的知识有可能通过通过 优化使用可用器官。通过执行这项工作，Cron博士将接受Mendored培训 定性方法论和临床移植科学，将其发展成独立的发展 外科医生科学家和移植手术的领导者。

项目成果

Increased volume of organ offers and decreased efficiency of kidney placement under circle-based kidney allocation.

在基于循环的肾脏分配下，器官供应量增加，肾脏放置效率降低。

• DOI: 10.1016/j.ajt.2023.05.005
• 发表时间: 2023
• 期刊: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
• 作者: Cron,DavidC;Husain,SyedA;King,KristenL;Mohan,Sumit;Adler,JoelT
• 通讯作者: Adler,JoelT

The Association of Dialysis Facility Payer Mix With Access to Kidney Transplantation.

• DOI: 10.1001/jamanetworkopen.2023.22803
• 发表时间: 2023-07-03
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: Cron, David C.;Tsai, Thomas C.;Patzer, Rachel E.;Husain, Syed A.;Xiang, Lingwei;Adler, Joel T.
• 通讯作者: Adler, Joel T.