Johns Hopkins Hospital Baltimore, Maryland, United States
Background/Case Studies: Extra vessels, obtained from organ donors, are used for vascular reconstruction in liver transplant recipients. These vessels, which have an expiration of up to 14 days, require meticulous documentation of disposition (United Network for Organ Sharing) and traceability in accordance with policies from the Organ Procurement and Transplantation Network (OPTN) and are subject to audits. Surgical procurement teams pack and label donor vessels with the donor identification, anatomic site, recovery date, donor ABO group (and subtype if indicated), and infectious disease testing results (all vessel donors are screened for HIV 1/2, Hepatitis B and C viruses). The transplant center at our hospital urgently required an internal system for receipt, storage, and dispensing of vessels; these functions were overseen previously by an external non-profit organ procurement organization.
Study
Design/Methods: The transfusion medicine based hospital tissue service (HTS) developed a comprehensive process for vessel receipt, storage, discard, issue, tracking, tracing, and transfer to outside institutions. Using data from tissue tracking software, this retrospective study sought to describe vessel storage, disposition, and lessons learned over a one-year period post-inception from 4/4/23-4/4/24.
Results/Findings: The HTS received 152 containers with vessels from 89 donors, whereas 13 vessel containers were precluded from storage in the HTS due to positive infectious disease testing. Of these 152, 57% (87/152), 24% (37/152), 15% (23/152), 3% (5/152) were from group O, A, B, and AB donors, respectively. For the 37 vessels labeled as group A, 11/37 (30%) were subtyped as group A1 and of the 5 vessels labeled as AB, 1/5 (20%) was subtyped as A1B. Vessel p</span>acking methods varied with some packed individually (e.g., right iliac vessel) and others packed together (e.g., bilateral iliac vessels). Extra vessel disposition was as follows: 2% (3/152) were discarded immediately due lack of receipt on ice, 3% (5/152) were shipped to outside transplant hospitals, 16% (25/125) were issued to the operating room (OR), and 78% (119/152) expired and were discarded. Of the issued vessels, 15/25 (60%) were implanted into living donor liver transplant recipients, whereas 10/25 (40%) were discarded in the OR due to unacceptable vessel or packing quality (e.g., damage to inner sterile cup or sterile bag). Conclusions: After transitioning extra vessel management from a third-party organization to our HTS, we were able to maintain timely availability of vessels while meeting strict storage and documentation standards. The HTS integrated vessel storage into routine operations effectively. Vessel labeling practices (i.e., type of vessel) vary among recovery hospitals and require close communication with surgical teams to ensure accurate descriptions.
