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Why referred potential heart donors aren't used
P S Richards1, K A Nelson, O H Frazier
1LifeGift Organ and Tissue Donation Center, Houston, Texas.
Insights
Many potential heart donors are not utilized due to family refusal, medical unsuitability, or not meeting brain death criteria. Improving public and physician education is crucial for increasing organ donation rates.
Area of Science:
- Transplantation Science
- Public Health
- Medical Ethics
Background:
- The demand for heart transplantation significantly outweighs the available donor supply.
- Understanding reasons for underutilization of potential cardiac donors is critical for improving organ availability.
Purpose of the Study:
- To analyze the reasons behind the non-utilization of potential heart donors.
- To identify factors contributing to the gap between donor referrals and heart procurements.
Main Methods:
- Retrospective review of 430 donor referrals to a single organ procurement agency over two years (September 1989 - August 1991).
- Categorization of reasons for donor non-utilization: family consent, medical unsuitability, and failure to meet brain death criteria.
Main Results:
- Only 39% (169 of 430) of referred donors yielded hearts for transplantation.
- Key reasons for non-utilization included: family refusal (38.7%), medical unsuitability (36%), and not meeting brain death criteria (16.1%).
- Medical unsuitability was often due to cardiac arrest, hypotension, drug abuse, sepsis, or infections; a significant racial disparity was observed in donor utilization.
Conclusions:
- Strategies are needed to increase organ donation consent rates through public and physician education.
- Optimizing donor selection criteria and enhancing physician awareness of brain death protocols are essential.
- Addressing disparities in organ donation among racial and ethnic groups is a critical public health imperative.
Abstract:
Heart donor demand far exceeds supply. We evaluated donor referrals to 1 organ procurement agency in an attempt to determine why many potential cardiac donors are not used. Of 430 referrals between September 1989 and August 1991, 169 hearts (39%) were harvested. In potential donors ultimately not yielding a heart, 38.7% were unavailable because the family refused to consent to organ donation, 36% were medically unsuitable, and 16.1% did not meet standard brain death criteria. Of the 94 donors not used for medical reasons, 43.6% had cardiac arrest, 17% had hypotension, 12.8% were drug abusers, 6.4% had sepsis, 5.3% had hepatitis, 5.3% had an acute myocardial infarction, 3.2% had low ejection fraction levels, and 2.1% tested positive for human immunodeficiency virus or syphilis (4.3% were not specified). A significant difference (p = 0.001) in racial distribution surfaced; Blacks and Hispanics constituted 27.2% of the donor group but 46.3% of the non-donor group. These data confirm that strategies must be created to continue educating the public and physicians in order to increase consent rates, optimize donor selection, and improve physician awareness of brain death criteria.