Blood used organ donation services

[jtemple]

Recently, I had a situation that bothered me and I wanted to reach out to this knowledgeable group for opinions. A patient was going into the organ donor process. They wanted 4 or 5 units of blood. Unfortunately, the patient was O Negative and I could only offer them 2 units. So, the group handling it contacted a blood supplier and got three additional units and brought them into my hospital. Then proceeded to use them during the course of the process. My first question, should these units come through my blood bank? How can they not have these units tested at all?  No ABO recheck, no crossmatch, nothing. Now according to them as the patient has passed, they can do that. I can find no exception in the standards. Is there something I don't know? 

[Bet'naSBB]

On 9/4/2024 at 8:50 AM, jtemple said:

should these units come through my blood bank?

Absolutely!!

And, no, in my 36 years of blood banking - I have never heard of anything like this........... But, I do think that since they went "around" you, it's not "ON" you or your hospital.  The organ donation group handling the 3 - NON-Blood Bank provided units is now responsible for it.  Although, I do wonder how they will document the fact that the patient received the blood and who will be notified if there's a recall or lookback.....

[Cliff]

1 minute ago, Bet'naSBB said:

who will be notified if there's a recall or lookback.

As a former compliance guy, this is one of my concerns.  It's almost untrackable now.

[Neil Blumberg]

The standards probably don't apply to post-mortem transfusions.  I cannot imagine why an organ harvest surgery would require transfusion at all, but I'm not a surgeon.  I've had requests to transfuse platelets and plasma to organ donor patients, which we've uniformly denied.  I'd need some explanation of why transfusion, which is pro-inflammatory, immunomodulatory and pro-thrombotic, would benefit the potential organ recipient.  There is so much misinformation, partially promulgated by the transfusion medicine community, of the "benefits" of transfusion, that it is sometimes difficult to explain to clinicians why transfusion is a bad idea in many situations.

 

[John C. Staley]

On 9/4/2024 at 6:50 AM, jtemple said:

 So, the group handling it contacted a blood supplier and got three additional units and brought them into my hospital.  

I'm curious, how is this group affiliated with the hospital?  It seems to me that this is something that risk management should be made aware of and should, at the very least, be reviewed by the transfusion committee if your hospital has one.  

[Townsend]

Agree with all here.  Unless the organ procurement team is an external entity with their own contract with the blood supplier, this has to go through the blood bank.  I would definitely complete a hospital incident report and get to the bottom of it, both to track these blood products and to prevent this in the future.  Could the blood bank director have approved Rh positive units for this process?  Due to the number of units being requested, I'm betting this was for a deceased liver organ procurement using a machine such as the TransMedics OCS pump (linked here) - Transmedics OCS Liver pump - https://www.accessdata.fda.gov/cdrh_docs/pdf20/P200031D.pdf.  The info below is directly from pg 41-42 of their manual - this has come up recently at my facility and has opened up a big discussion about who is responsible for blood administration (including double-check at the bedside) and documentation!

Chapter 4 -Pre-retrieval Readiness:

• Packed Red Blood Cells (pRBCs) in a cooler
  • 4-8 units (~1500mL)
  • ABO type-matched (to transplant recipient)
  • Leukocyte-reduced

And mentioned again in Chapter 5 (System Setup)

[sgoertzen]

At my institution. the Donor Network is now asking for 4-6 units of RBCs for organ perfusion for their machine after the organ has been harvested (similar to ECMO for the organ).  Those RBC units will not ever touch the organ donor patient.  Our policy is to always issue them the oldest O Pos units (uncrossmatched) we have on our shelf.  They will rinse all of this banked blood out of the organ before transplanting it into the recipient, and it is added to the perfusate solution to provide oxygenation to the organ during transport from the donor hospital to the recipient hospital.  AABB offered at least 1 very informative session at their annual meeting on this last year in Nashville, and I'm guessing that they will offer more in Houston this year (or perhaps an eCast session or articles in AABB News or Transfusion) since this practice is becoming more and more widespread. The unique nature of the process is proving to be a challenge for hospital transfusion services as far as who places the order, what testing is needed (if any), tracking for final disposition, what kind of records need to be kept because they are not being "transfused", billing of the products, etc..