Neuroanesthesia & neurocritical care
Identifying Variation in Intraoperative Management of Brain-Dead Organ Donors and Opportunities for Improvement: A Multicenter Perioperative Outcomes Group Analysis
An erratum to this article was published (Anesth Analg, 1 May 2025 ↗)
Authors' conclusion
Despite guidelines recommending maintenance of MAP >60 mm Hg in adult brain-dead organ donors, hypotension during recovery procedures was common.
Study context
- Population
- Brain-dead adult organ donors undergoing organ recovery procedures, 14 US hospitals and 4 organ procurement organization (OPO) regions (2014–2020)
- Participants
- 1,338 donors · 14 US hospitals
- Exposure
- 18 to 34 years vs 35 to 64 years vs 65 years and older
- Outcome
- Hypotension (MAP <60 mm Hg for at least 10 cumulative minutes)
- Follow-up
- Entire intraoperative monitoring period
Methodological detailsmulticentre, registry (Multicenter Perioperative Outcomes Group (MPOG) electronic anaesthetic records)
- Multicentre
- Registry (MPOG electronic anaesthetic records)
Main finding
As reported in the abstract
Hypotension (MAP <60 mm Hg for ≥10 cumulative minutes)
| Group | Value | 95% CI | Median % of monitoring period hypotensive | Hypotension duration, minutes (median, quartile1-quartile 3) |
|---|---|---|---|---|
| Donors | 24% | 22%-26% | 13.8% [quartile1-quartile 3: 9.4%-21%] | 17, 12-24 (minimum 10, maximum 96) |
Donors
Value24%
95% CI22%-26%
Median % of monitoring period hypotensive13.8% [quartile1-quartile 3: 9.4%-21%]
Hypotension duration, minutes (median, quartile1-quartile 3)17, 12-24 (minimum 10, maximum 96)
Observational data: associations, not effects.
Further findings
| Outcome | Values | aRR (95% CI) | |
|---|---|---|---|
| Hypotension by donor age (vs 18 to 34 years)35 to 64 years vs 18 to 34 years | 0.68 (0.55–0.82) | ||
| Hypotension by donor age (vs 18 to 34 years)65 years and older vs 18 to 34 years | 0.63 (0.42–0.94) | ||
| 0.512Adjusted relative risk (log scale) |
| Outcome | Values |
|---|---|
| Intraoperative medication use | Donors intravenous heparin 96.4%, n = 1291 · neuromuscular blockers 89.5%, n = 1198 · vasoactive medications 82.7%, n = 1108 · crystalloids 76.2%, n = 1020 · halogenated anesthetic gases 63.5%, n = 850 · diuretics 43.8%, n = 587 · steroids 16.7%, n = 224 · opioids 23.2%, n = 310 |
- Hypotension by donor age (vs 18 to 34 years): multivariable mixed-effects Poisson regression with robust SE
Practice heterogeneity between MPOG centers and OPO regions (ICC)
- Steroids, between-center ICC
- 0.65 (95% CI 0.62-0.75)
- Steroids, between-region ICC
- 0.39 (95% CI 0.27-0.63)
- Diuretics, between-center ICC
- 0.44 (95% CI 0.36-0.6)
- Diuretics, between-region ICC
- 0.30 (95% CI 0.22-0.49)
- Largest practice heterogeneity observed
Original publication
Identifying Variation in Intraoperative Management of Brain-Dead Organ Donors and Opportunities for Improvement: A Multicenter Perioperative Outcomes Group Analysis. Anesth Analg. Published 25 July 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →