311 - MOVING BEYOND THE PERFECT DONOR: QUALITY IMPROVEMENT (QI) INITIATIVE TO OPTIMIZE DONOR UTILIZATION

Background: Despite a growing demand of donor hearts, a significant portion of viable hearts are being discarded in North America. The objective of our QI initiative was to review local donor acceptance practices and evaluate the impact of interventions to standardize clinical practice. The primary aim was to increase utilization to 20%. The secondary aim was to minimize missed viable opportunities to less than 10% to reflect a clinically meaningful increase. The third aim was to assess short term outcomes including severe primary graft dysfunction (PGD).

METHODS AND RESULTS: Single-centre QI study including all prospective donor heart offers from January 2021 to December 2023. Donor demographics, clinical data and utilization outcomes were collected and managed using a REDCap platform. Missed viable opportunities were defined as: LVEF >50%, age < 45 years, anticipated ischemic time < 4 hours, and absence of size mismatch. Our QI interventions started in January 2023 and included: creation of dashboard with monthly data updates to summarize recent donor acceptance patterns; incentivizing the most comprehensive donor decline rationale; invited speaker discussion panels to provide feedback on decline offers; and routine administration of levothyroxine. All statistical analysis assumed a significance of P < 0.05. Prior to the QI intervention, 54 of 436 donor offers (12%) were used; following the intervention, 43 of 233 offers (18.4%) were used. The proportion of missed viable opportunities in 2023 was reduced compared to 2021-2022 (8.6% vs 19.3%). There was no difference in severe PGD (2021-2022) 13.7% vs (2023) 9.3% (p=0.50).


Conclusion: Our QI interventions which included iterative feedback and evaluation of donor acceptance practices doubled the utilization rate and halved the missed viable opportunity rate in 2023 compared to 2022 without compromising short term outcomes.