Institutional Variability in Brain-Dead Organ Donation Processes and Practices: A Multicenter Cohort Study

Area of Science:

• Organ transplantation research
• Critical care medicine
• Public health policy

Background:

• Brain-dead organ donation is crucial for addressing organ shortages.
• Variations in hospital practices may influence donation rates.
• Understanding institutional differences is key to optimizing donation processes.

Purpose of the Study:

• To identify institutional and clinical differences between high- and moderate-activity brain-dead organ donation hospitals in Japan.
• To compare donor management strategies and timelines.
• To inform strategies for improving organ donation rates.

Main Methods:

• Retrospective multicenter cohort study of 204 brain-dead organ donors across 16 Japanese tertiary centers (2010-2023).
• Hospitals classified as highly active (≥14 donations) or moderately active (≤13 donations).
• Comparison of donor management, time intervals, and multidisciplinary team engagement.

Main Results:

• Highly active hospitals used corticosteroids more frequently (58.3% vs. 38.0%).
• Longer median times to family consent (8 vs. 5 days) and organ procurement (12 vs. 9 days) in highly active hospitals.
• Highly active hospitals held more multidisciplinary meetings (median 2 vs. 0).

Conclusions:

• Intensive donor management, longer donation process timelines, and increased multidisciplinary collaboration characterize highly active donation hospitals.
• Standardizing practices could enhance efficiency and disseminate effective strategies to boost brain-dead organ donation in Japan.