The Effect of Trauma Center Designation on Organ Donor Outcomes in Southern California ALI SALIM, M.D.,* CHERISSE BERRY, M.D.,* ERIC J. LEY, M.D.,* DANIELLE SCHULMAN, M.P.H.,* MARKO BUKUR, M.D.,* DANIEL R.MARGULIES, M.D.,* SONIA NAVARRO,† DARREN MALINOSKI, M.D.* From the *Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California; and the †OneLegacy Organ Procurement Organization, Los Angeles, California We sought to investigate the effect of trauma center designation on organ donor outcomes during a 5-year period. A retrospective study of the southern California regional Organ Procurement Organization database comparing trauma centers (n 5 25) versus nontrauma centers (n 5 171) and Level I (n 5 7) versus Level II (n 5 18) trauma centers between 2004 and 2008 was performed. A total of 16,830 referrals were evaluated and 44 per cent were from trauma centers. When compared with nontrauma centers (n 5 171), trauma centers (n 5 25) had a higher percentage of medically suitable eligible deaths (29 vs 16%, P \ 0.001), total eligible deaths (22 vs 12%, P \ 0.001), and eligible donors (14 vs 7%, P \ 0.001). Trauma Centers had a significantly higher number of organs procured per donor (4.0 6 1.6 vs 3.5 6 1.6, P \ 0.001), organs transplanted per donor (OTPD) (3.6 6 1.8 vs 2.8 6 1.8, P \ 0.001), and higher organ yield (per cent 4 or greater OTPD [48 vs 31%, P \ 0.001]). No significant differences were found between Level I and Level II trauma centers. Trauma centers demonstrate significantly better organ donor outcomes compared with nontrauma centers. Factors responsible for improved outcomes at trauma centers should be evaluated, reproduced, and disseminated to nontrauma centers to alleviate the growing organ shortage crisis. T ODAY’S TECHNOLOGICAL advancements in transplan- tation have advanced organ donation into a com- mon and culturally accepted practice. However, with the shortage of organs and inexhaustible waiting lists, many people are still dying from a lack of life-saving trans- plants. To address this ongoing public health crisis, nu- merous governmental and nongovernmental initiatives were introduced in recent years. These initiatives have resulted in modest success with increases in the number of deceased donors and in organ availability. 1–3 Trauma centers are uniquely qualified to positively affect the organ donor shortage and are required to participate in organ procurement activities to become appropriately verified by the American College of Surgeons. 4 With their mandate to contribute adminis- trative leadership, medical leadership, and academic expertise to a state or region, 4 trauma centers possess the resources and expertise to provide the necessary support to manage potential organ donors, thereby increasing the organ yield and the number of organs available for transplantation. To date, no studies have addressed the effect of trauma center designation on organ donor outcomes. The purpose of this study was to determine how southern California trauma centers affect donor outcomes. Our hypothesis was trauma center designation is associated with improved organ donor outcomes compared with nontrauma centers. Patients and Methods This is a retrospective study using an existing data- base from the southern California regional organ pro- curement organization (OPO)O, OneLegacy, which covers 14 transplant centers and more than 220 donor hospitals. 5 This OPO serves over 18.3 million people in Los Angeles, Kern, Orange, Riverside, San Bernardino, Santa Barbara, and Ventura counties. The records of patients referred to the OPO for possible organ donation between the years 2004 and 2008 were reviewed. Data regarding the number of referrals for organ donation, eligible deaths, eligible donors, each type of donor, organs procured per donor (OPPD), organs transplanted per donor (OTPD), and organs transplanted per eligible death (OTPED) were recorded. OTPED reflects the effectiveness of the entire donation process because it Presented as a poster presentation at the American Association for the Surgery of Trauma 69th Scientific Meeting, September 22– 25, Boston, Massachusetts. Supported by the National Institute of Diabetes and Digestive and Kidney Diseases grant Number 5RO1DK079667. Address correspondence and reprint requests to Ali Salim, M.D., Cedars-Sinai Medical Center, Department of Surgery, 8700 Beverly Boulevard, Suite 8215N, Los Angeles, CA 90048. E-mail: ali.salim@cshs.org. 535