Age-stratified Data Highlight Worldwide Variability in Organ Donation Rates and the Potential Increase in Organ...

Ongoing shortages of organs for transplantation have prompted the critical question of which countries have the highest organ donation rates and how each can increase those rates. The existing metric of donors per million population is flawed because it does not sufficiently account for important differences in the underlying population, including age distributions of deaths in the population.

We sought to develop a better approach to analyze country-specific data on organ donation, including deaths stratified by age, to allow assessment of performance across the world. We used death data from the World Health Organization and donation data from 17 countries across 3 continents. We calculated age group-stratified organ donation rates as donors per 1000 deaths and estimated each country's potential to increase donation if the age group-specific donation rate mirrored that of the highest-performing country in each age group.

There was a 4-fold difference in overall donation rates, with far greater variability within age strata, including a 10-fold difference in donation rates for the oldest age group (70 y and older). The United States showed the greatest potential to increase donations in absolute terms (>8000 increased donors per year), whereas Argentina, Germany, and Hungary had the greatest potential in relative terms.

Although countries may have similar overall donation rates, the breakdown within specific age groups varies widely. Examining age-specific donation rates is a necessary step for accurate international comparisons of transplant systems and can enable targeted interventions to augment donation.