Safety Risks in Living Donor Liver Transplantation

[Clark]

http://www.atcmeetingabstracts.com/abstract/safety-risks-in-living-donor-liver-transplantation/

Safety Risks in Living Donor Liver Transplantation
D. Woods, T. Berzins, E. Pomfret, M. Simpson, R. Brown, R. Fisher, A. Daud, T. Trenski, K. Waitzman, J. Holl, D. Ladner

OBJECTIVE/BACKGROUND:

According to the 2010 U.S. Office of the Inspector General’s Report, adverse events (AE) are common in the care of patients. In Living Donor Liver Transplantation (LDLT), given that living donors are healthy volunteers undergoing a major procedure purely for altruistic reasons, without any direct benefit for their own health, prevention of such events is particularly important, when caring for living donors and for the recipients to which they are donating. To inform critical targets for improvement to reduce AEs, we performed a review of medical records at four LDLT centers, to identify AEs as well as systems and process errors.

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DISCUSSION:

This study demonstrates that AEs were common in LDLT. Given the results that AEs occurred in the care of 100% of donors and in the care of 100% of recipients it is critical to address these patients’ risks. These data can provide guidance to direct toward targets for improvement to reduce AEs and improve the overall safety and care outcomes of LDLT.

[Clark]

http://www.atcmeetingabstracts.com/abstract/safety-issues-identified-by-proactive-liver-transplant-safety-debriefing/

Safety Issues Identified by Proactive Liver Transplant Safety Debriefing
D. Ladner, T. Berzins, L. Pomfret, M. Simpson, R. Brown, R. Fisher, A. Daud, T. Strenski, L. McElroy, J. Holl, D. Woods

BACKGROUND: Transplantation and, in particular, living donor liver transplantation (LDLT), involves complex systems and process of care that are particularly susceptible to medical errors and preventable complications. In order to capture safety issues during LDLT procedures, a proactive, web-based clinician safety debriefing tool was developed and implemented at four Adult-to Adult Living Donor Liver Transplant (A2ALL) hospitals. METHODS: All clinicians at four A2ALL centers who participated in LDLT procedures (Donor, Recipient) between Sept. 2012 and Oct. 2012 received a request to complete the web-based Safety Debriefing via email immediately after an LDLT surgery. The debriefing tool takes less than 3min to complete and provides clinicians with 24 prompts (e.g. “Access to Necessary Clinical Data”, “ABO Matching”) to elicit recollections of complications, near miss events and other safety issues that occurred. Reporters were identified, but answers were anonymous.

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CONCLUSIONS: Anonymous, short, online debriefings can successfully elicit rich information on the safety risk associated with LDLT surgery far beyond hospital wide reporting systems, which captured less than 5% of safety issues related to LDLT surgeries reported in the online debriefings. This is supporting evidence that to date safety risks associated with LDLT are poorly described and vastly underestimated. The proactive comprehensive safety risk assessment of LDLT is crucial in the quest to perform safety LDLT surgeries for donors and recipients.

[Clark]

http://www.atcmeetingabstracts.com/abstract/psychosocial-outcomes-3-to-9-years-after-living-liver-donation-in-the-adult-to-adult-living-donor-liver-transplantation-cohort-study-a2all/

Psychosocial Outcomes 3 to 9 Years after Living Liver Donation in the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL)
M. Dew, Z. Butt, A. DiMartini, D. Ladner, M. Simpson

Background: Psychosocial outcomes data come primarily from the first few years post liver donation and are based largely on generic quality of life measures that are insensitive to donation-related issues. We examined donors' perceptions of the consequences of donation on their well-being in the long-term postdonation.

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Conclusions: Even many years postdonation, substantial percentages of donors report adverse physical and socioeconomic effects of donation, but positive emotional effects as well. Clinical follow-up should monitor donor concerns and provide intervention or referrals for care. Some donor subgroups (e.g., those whose recipient died) may warrant heightened surveillance.