Organ donation after trauma: a cluster analysis

Abstract Background: Solid organ transplantation remains a critical treatment for organ failure, yet organ shortages persist globally. Trauma patients account for approximately 30% of deceased organ donors. Damage control strategies (DCS) are employed in trauma care to stabilize patients, but their impact on organ suitability for transplantation remains unclear. This study aims to characterize subtypes of trauma organ donors and examine the relationship between DCS application and organ donation outcomes. Methods: A retrospective observational cohort study was conducted across three major trauma centers in Northern Italy, analyzing trauma donors from January 2012 to September 2021. Data were collected on trauma severity, hemodynamic status, damage control interventions, and organ donation outcomes. Machine learning cluster analysis was applied to identify donor subgroups based on clinical and physiological variables. Results: A total of 117 trauma donors were analyzed. Two main donor clusters were identified: (1) younger patients with multi-system traumatic injuries, hemodynamic instability, and aggressive resuscitation efforts, and (2) older patients with primarily isolated traumatic brain injuries and minimal damage control interventions. Despite greater physiological derangement, Cluster 1 donors yielded significantly more solid organs per donor, including a higher rate of heart donation (65% vs. 34%, p = 0.001). Functional outcomes of transplanted organs at 30 days were similar between groups (93% vs. 93%). Conclusion: This study suggests that aggressive resuscitation and DCS do not compromise organ suitability for transplantation and may, in fact, enhance organ yield in trauma donors. These findings highlight the importance of considering organ donation as a meaningful outcome in patients with non-survivable injuries.