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The pattern of organ donation in a large urban center
N Sumrani1, V Delaney, K M Butt
1Department of Surgery, State University of New York Health Science Center, Brooklyn 11203.
Insights
Organ procurement in New York remained stagnant despite rising referrals, with low consent rates among Black populations being a key factor. Addressing educational efforts and hospital protocols is crucial for improving organ donation rates.
Area of Science:
- Medical Ethics
- Public Health Policy
- Transplantation Medicine
Background:
- Organ procurement in metropolitan New York showed no improvement between 1983 and 1988, despite increasing referrals.
- Procurement rates remained at 9-13 per million population, failing to meet escalating demand.
Purpose of the Study:
- To analyze the reasons behind the stagnation in organ procurement rates.
- To identify factors contributing to low consent for organ donation and explore potential corrective measures.
Main Methods:
- Retrospective analysis of organ donation and procurement data in metropolitan New York from 1983-1988.
- Examination of exclusion criteria, including increased human immunodeficiency virus (HIV) disease prevalence.
- Assessment of consent rates across different racial and ethnic groups.
Main Results:
- Procurement rates remained unchanged despite increased referrals.
- Human immunodeficiency virus (HIV) disease or risk thereof accounted for 38% of exclusions.
- Organ donation consent rates were low among Black individuals (24%), increased for Hispanics (17% to 47%), and remained high but stagnant for Whites.
Conclusions:
- Stagnation in organ procurement is not due to delayed brain death diagnosis or increased medical unsuitability, apart from HIV.
- Low consent rates, particularly among Black populations, and systemic issues like unfocused education and hospital insensitivity hinder donation.
- Improving organ donation requires addressing educational strategies, enhancing family sensitivity, and potentially re-evaluating inter-agency competition.
Abstract:
Despite increasing referrals for organ donation in metropolitan New York, procurement has remained essentially unchanged from 1983 through 1988 at 9 to 13 per million population, falling far short of increasing demand. This is not due to delay in the diagnosis of brain death, higher discard rates, or increased medical unsuitability, although exclusion because of human immunodeficiency virus (HIV) disease, or risk thereof, has increased and now accounts for 38% of exclusions. Consent for organ donation remains consistently low among blacks (24%), has increased among Hispanics from 17% in 1984 to 47% in 1988, and remains the highest, but without improvement, among whites. Causes for the observed stagnation and potential corrective factors include poorly focused educational efforts, lack of sensitivity to the grieving family by hospital personnel, physician frustration at the increasingly prominent role of government and its regulations in the practice of medicine, and eradication of competition between local organ procurement agencies.