Alveolar Lung Recruitment Maneuver Utilization among Transplant Clinicians in Arizona

Abstract

The reservation of lung transplant procedures as a final treatment measure for patients with acquired end-stage pulmonary disease is partly due to the lack of supply, which mostly comes from brain dead donors. Separate from the other life-saving transplantable organs that have progressively increased in transplant rates over the last decade, the national ratio of lung transplantation has remained stagnant (Bergstrom, 2018). Transplant clinicians medically manage authorized brain dead organ donors in Arizona (AZ) according to their clinical judgment that is supplemented by the Organ Procurement Organizations (OPO) Clinical Practice Guidelines (CPG). The goal is to maximize the gift of donation by increasing the number of organs transplanted per donor (OTPD). The United Network for Organ Sharing (UNOS) sets the benchmark for the Expected (E) OTPD, and in AZ the Observed (O) OTPD ratio (i.e., O: E) has been below that benchmark. Meeting the organ-specific diagnostic endpoints of the Donor Management Goals (DMG) demonstrate organ system recovery and suitability for transplant. Alveolar recruitment maneuvers were at the forefront of the pulmonary management regimes of potential lung donors, and there were three in the CPGs at Donor Network of Arizona (DNAZ), the federally designated OPO of AZ. Each of the three methods have been tested at DNAZ in the past years and each has shown some ability to improve lung transplant rates but, clear superiority of one method has not been definitively established. Despite the prior utilization of these measures, according to an analysis of CPGs utilized and DMGs met, the use of the techniques has waned in the last year. Underutilization of alveolar recruitment maneuvers was the suspected reasoning behind the O: E gap. This project used theoretical foundations that aimed to improve utilization of the DNAZ CPGs by; (1) exploring the reasoning behind why they are avoided, (2) creating and presenting a learning lesson based on that assessment (3) evaluating the learning lesson and (4) closing the O: E gap by improving transplant metrics.