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Potential for deceased donation not optimally exploited: donor action data from six countries
Leo Roels1, Jacqueline Smits, Bernard Cohen
1Donor Action Foundation, Prinsendreef 10, B-3210 Linden, Belgium. info@donoraction.org
Insights
Over half of potential deceased organ donors are missed due to identification, referral, or consent issues. Optimizing deceased donation practices is crucial to increase the organ pool alongside living donation efforts.
Area of Science:
- Organ transplantation research
- Public health policy
- Critical care medicine
Background:
- Living organ donation is promoted globally to address organ shortages.
- The effectiveness of deceased organ donation requires optimal exploitation of its potential.
Purpose of the Study:
- To assess the conversion rate of potential heart-beating deceased donors into actual donors across six countries.
- To identify key points of loss in the deceased organ donation pathway.
Main Methods:
- Utilized the Donor Action (DA) Medical Record Review (MRR) methodology.
- Analyzed data from 52,383 deceased patients across 605 critical care units in 227 hospitals (2007-2009).
- Focused on ventilated patients eligible for heart-beating donation.
Main Results:
- Out of 17,903 eligible patients, 4,855 were potential heart-beating donors.
- On average, 24.8% were not identified, 21.9% not referred, and 11.3% not approached for donation.
- The conversion rate from potential to actual donors was 42.1%, with consent rates at 69.1%.
Conclusions:
- More than 57% of potential deceased organ donors were missed in the donation pathway.
- Missed opportunities included non-identification, non-referral, lack of family approach, or objections.
- Enhancing deceased organ donation practices is vital to increase the organ supply, complementing living donation initiatives.
Background:
Most countries today promote living donation as an alternative to challenge the organ shortage from deceased donors. This seems justifiable provided the potential for deceased donation is optimally exploited.
Methods:
We used the Donor Action (DA) Medical Record Review (MRR) methodology in six countries, to measure whether the potential for heart-beating (HB) deceased donors was adequately converted to donation. Medical record review data were collected from 52,383 patients who died in 605 critical care units in 227 hospitals between January 2007 and December 2009.
Results:
On a total of 17,903 ventilated patients aged younger than 76 years and without contraindications to HB donation, 4,855 cases met criteria for brain death (BD) diagnosis and were considered potential HB donors. On average, 24.8±15.9% was not identified as potential donor, 21.9% of identified cases was not referred as such to a procurement team, and in 11.3% of identified cases, no approached was offered with the option to donate. Average consent rates/family approaches or registry consultation was 69.1±14.5%, and average conversion of potential into actual donors was 42.1±7.3%.
Conclusions:
Over 57% of deceased potential donors in the study cohort were missed along the donation pathway because of nonidentification, no referral, no approach of relatives, or objections to donate. In countries with lower donation rates, expectedly more potential donors are missed proportionally. Efforts to increase the organ pool should therefore focus on optimizing clinical practices in deceased organ donation in addition to promoting living organ donation.
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