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Kidney Week

Abstract: FR-PO794

Strategies to Increase Deceased Organ Donation: A Single-Center Experience from an Inner-City Hospital in the Bronx

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Pena, Oscar Yasser, New York City Health and Hospitals Jacobi, Bronx, New York, United States
  • Kolli, Shiny Teja, NYC Health and Hospitals North Central Bronx, New York, New York, United States
  • Bejugam, Vishal Reddy, NYC Health and Hospitals North Central Bronx, New York, New York, United States
  • Todor, Roxanne, New York City Health and Hospitals Jacobi, Bronx, New York, United States
  • Acharya, Anjali, New York City Health and Hospitals Jacobi, Bronx, New York, United States
Background

Kidney transplantation is the treatment of choice for end-stage kidney disease as it improves the quality of life and reduces the mortality risk. However, the average wait time ranges from 4 months to > 6 years, with 1 out of 20 (5%) patients dying each year while waiting. According to a 2022 report by the New York Organ Donor Network, the Bronx has the lowest organ donation rate at 11.3% vs. 18.1% in New York City. The Bronx had the highest number of people on the waiting list, with 1,500 people. Several factors, including SDOH contribute to the Bronx's low organ donation rate.

Centers for Medicare & Medicaid Services (CMS) introduced the End Stage Renal Disease Treatment Choices Learning Collaborative (ETCLC) in August 2021 with the goal to accomplish one of the goals of the Advancing American Kidney Health by increasing kidney transplants.

Methods

From June 2020 to March 2022. We excluded patients under 18 years old and those who died upon arrival. Electronic medical records were reviewed, and statistical analysis was performed using StataBE17.

Results

There were a total of 375 patient deaths. Of these, 212 were male (56.53%), and 163 were female (43.47%). The mean age was 68.9 years.Thirty-three patients (8.8%) were diagnosed with brain death. Of these, 14 patients (42%) became organ donors.
Acute kidney injury (AKI) was present in 42% of patients with brain death. The breakdown of AKI severity was as follows:
KDIGO I: 28%
KDIGO II: 50%
KDIGO III: 22%
Timely referral to the OPO was made in 65% of the cases. Nephrology was contacted for 12% of these patients and all 12% required kidney replacement therapy

Conclusion

Identifying the missed opportunities for deceased organ donations is the first step in improving the process. We have implemented processes such as ongoing education of the stake holders and we are committed to working with our partners at the New York Organ Donor Network to ensure that every eligible patient has the opportunity to receive a life-saving organ transplant.

June 2021 - March 2022 Observations (%)
Deceased Patients375 total
SexMale212 (56.53%)Female163 (43.47%)
AgeMean 68.9 years
Brain death (BD)33 (8.8%) of 375Harvest Organs 14 (42%) of 33
AKI in BD19 (57%)KDIGO I
4 (12%)
KDIGO II
7 (21%)
KDIGO III
3 (9%)
KRT in BD4 (12%)KRT in Harvest Organ patient 1 (3%)
Nephrology consulted BD4 (12%)

Brain dead (BD), Kidney replacement therapy (KRT), Acute KIdney Injury (AKI)