THE RISKS, BENEFITS, AND COSTS OF EXPANDING DONOR CRITERIA - A COLLABORATIVE PROSPECTIVE 3-YEAR STUDY

The study purpose was to identify risks, benefits and costs associated with an expanded donor protocol. The protocol design evaluated organs rescued using expanded donor criteria and weighed all costs associate d with doing so. Costs were measured against conditions experienced wi th expanded and traditional criteria and recipient outcome. Traditiona l donors were between 5 and 55, with negative serologies, and no histo ry of hypertension or diabetes. ''Expanded donors'' were between 55 an d 75 or less than 5, with a history of hypertension, diabetes and/or s ere-positive for Hepatitis C. During this study 73 donors met criteria from which 200 organs were transplanted. De fined costs and outcomes for recipients were tracked. Using expanded criteria: costs averaged 2 0% more per organ; OPO personnel spent an average of 6 hours more time on-site; an additional 1214 hours in placement activity;and average o rgans per donor decreased. Heart patient and graft survival rates for traditional and expanded donor organs were comparable. Kidney patients transplanted from this pool experienced a decrease in patient (P=.14) and a significant decrease in graft (P=.02) survival rates. Patient ( P=.05) and graft (P=.01) survival rates were significantly lower in li ver patients transplanted with expanded donor organs. Two hundred tran splants occurred using expanded donor criteria. Costs for the OPO incr eased appreciably. Heart and kidney utilization hom these donors seems justified. It is thought that liver recipients' results were due to u tilizing them in sicker patients. Recovery of organs from donors using expanded criteria appears to be a reasonable way of increasing organ supply.