1. UNIVERSITY OF UTAH SCHOOL OF MEDICINE Donor Management Goals:
A Transplant Center Perspective
(as viewed by a practicing nephrologist & researcher)
Isaac E. Hall, MD, MS Assistant Professor of Medicine University of Utah School of Medicine Department of Internal Medicine
Division of Nephrology & Hypertension

2. Should transplant centers care about DMGs?
More DMGs met associates with:
more organs procured from those donors (including “expanded criteria donors”)1-3
less delayed graft function (DGF) in kidney transplants4
Increased utilization of livers5
1. Malinoski et al. J Trauma. 2011;71: 990-6
2. Malinoski et al. Crit Care Med. 2012; 40:2773–2780
3. Patel et al. JAMA Surg. 2014; 149:969-75
4. Malinoski et al. Am J Transplant. 2013; 13:
5. Bloom et al. J Am Coll Surg. 2015; 220:38-47

3. There are potential challenges/concerns about transplant centers using DMGs.
“Not meeting DMGs” could be a new reason to decline offers
“# of DMGs met” at a defined time-point or even “change in # met between time-points” may just represent underlying donor characteristics (i.e., not modifiable)
A cause-and-effect relationship between DMGs and allograft outcomes is difficult to prove using observational data

4. How might the field benefit as a whole?
If improvements can be made in meeting DMGs:
It might increase the organ pool and number of lives saved by transplant
It might prolong allograft survival and reduce the need for re-transplantation

5. DMG data are available for use by centers
Centers can consider ongoing review of recent DMG data during regular quality assurance / process improvement (QAPI) meetings
For turned-down offers accepted elsewhere, would we have reconsidered if we knew the # of DMGs met had been increasing?
It may be premature to use DMG data in real-time to make yes/no decisions about organ offers now

6. Centers might want to consider DMGs when deciding about early treatments
Adjusted odds ratio of DGF when “DMGs met” (≥7 out of 9 DMGs achieved) was about 0.51
Alternatively, can consider the inverse...if at least 7 DMGs not met, DGF was twice as likely
If DGF is likely, may be reason to:
Therapeutically pump kidney
Shorten cold ischemia time
Augment induction regimen
Delay intro of CNIs
More aggressively support BP
Preemptively dialyze post-op
Consider other novel therapies
1. Malinoski et al. Am J Transplant. 2013; 13:

7. Summary – what should centers do with DMGs?
DMGs might be most enlightening during QAPI review
Determining how to use new data clinically once we’ve decided we probably should can still be difficult
Additional studies are needed to see if “DMGs met” is a reliable surrogate marker for hard transplant outcomes