The Value of Chest and Abdominal CT Scans in Deceased Organ Donor Screening: A Prospective Nationwide Cohort Study

BACKGROUND: Standard computed tomography (CT) scanning in deceased organ donor screening may offer advantages over conventional chest radiograph and abdominal ultrasound.

METHODS: A nationwide prospective cohort study in the Netherlands was conducted, including all deceased organ donors between July 2022 and April 2024. There were 2 groups: those who received standard chest and abdominal CT scan (study group, n = 330) with a new standardized scan protocol and those screened according to the current protocol (chest radiograph and abdominal ultrasound, n = 224, or chest or abdominal CT scan already performed in the clinical workup, n = 162, together the control group, n = 386). Outcomes included the detection of suspicious lesions during screening or procurement, the incidence of procurement-related injuries, explantation time, and transplant outcomes.

RESULTS: During screening, suspicious lesions were identified in 19 donors (5.8%) in the study group and in 2 donors (0.5%) in the control group (P < 0.01). This resulted in more biopsies, but the majority were benign. During procurement, suspicious and unexpected lesions were identified in 2 donors (0.7%) in the study group and in 7 donors (2.2%) in the control group (P = 0.13). Kidneys from the study group had a lower rate of procurement-related injuries (16% versus control 23%; P < 0.01). No significant difference was observed for livers and pancreases. Nephrectomy (36 versus 39 min) and hepatectomy (31 versus 33 min) times were significantly shorter in the study group. No significant difference in kidney function up to 1-y posttransplantation was seen.

CONCLUSIONS: In conclusion, CT scanning improves deceased donor screening by reducing unexpected findings during procurement, thereby lowering the risk of procurement-related kidney graft injuries and shortening explantation times.