An In-House Coordinator Program to Increase Organ Donation in Public Trauma Hospitals

A 4-year retrospective study was conducted regarding the donor potential, consent rates, and organ recovery at a large 500-bed public trauma hospital. An independent organ procurement organization hired two in-house coordinators, one white and one black, to work exclusively in the hospital. The duties of the in-house coordinators included the following: working with nurses, physicians, and residents to identify donors; closely managing and coordinating the consent process; and assisting organ procurement coordinators in donor management. Following the program's implementation and the use of race-specific requesters, a 64% increase in consent rate resulted along with an overall increase of 94% in the number of organ donors. The consent rate of blacks increased 115%, whereas the number of black organ donors increased 154%. The Hispanic consent rate increased 48% with a corresponding increase of 83% in the number of Hispanic organ donors. In addition, the white consent rate increased from 55% (the 3-year average from 1993 to 1995) to 75% in 1996, resulting in a 36% increase following the implementation of the program. The investment of dedicated race-sensitive personnel in large urban county trauma facilities can result in a significant increase in donor conversion rates.

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Comparison of 1 vs 2 Brain Death Examinations on Time to Death Pronouncement and Organ Donation

Neurology ◽

10.1212/wnl.0000000000011554 ◽

2021 ◽

Vol 96 (10) ◽

pp. e1453-e1461

Author(s):

Panayiotis N. Varelas ◽

Mohammed Rehman ◽

Chandan Mehta ◽

Lisa Louchart ◽

Lonni Schultz ◽

...

Keyword(s):

Brain Death ◽

Organ Donation ◽

Brain Function ◽

Brain Injuries ◽

Organ Procurement ◽

Tertiary Hospital ◽

Consent Rate ◽

Organ Procurement Organization ◽

Time To Death ◽

Elapsed Time

ObjectiveTo fill the evidence gap on the value of a single brain death (SBD) or dual brain death (DBD) examination by providing data on irreversibility of brain function, organ donation consent, and transplantation.MethodsTwelve-year tertiary hospital and organ procurement organization data on brain death (BD) were combined and outcomes, including consent rate for organ donation and organs recovered and transplanted after SBD and DBD, were compared after multiple adjustments for covariates.ResultsA total of 266 patients were declared BD, 122 after SBD and 144 after DBD. Time from event to BD declaration was longer by an average of 20.9 hours after DBD (p = 0.003). Seventy-five (73%) families of patients with SBD and 86 (72%) with DBD consented for organ donation (p = 0.79). The number of BD examinations was not a predictor for consent. No patient regained brain function during the periods following BD. Patients with SBD were more likely to have at least 1 lung transplanted (p = 0.031). The number of organs transplanted was associated with the number of examinations (β coefficient [95% confidence interval] −0.5 [−0.97 to −0.02]; p = 0.044), along with age (for 5-year increase, −0.36 [−0.43 to −0.29]; p < 0.001) and PaO2 level (for 10 mm Hg increase, 0.026 [0.008–0.044]; p = 0.005) and decreased as the elapsed time to BD declaration increased (p = 0.019).ConclusionsA single neurologic examination to determine BD is sufficient in patients with nonanoxic catastrophic brain injuries. A second examination is without additional yield in this group and its delay reduces the number of organs transplanted.

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LO66: Solid organ donation from the emergency department: A death review

CJEM ◽

10.1017/cem.2019.109 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S31-S32

Author(s):

J. McCallum ◽

R. Yip ◽

S. Dhanani ◽

I. Stiell

Keyword(s):

Emergency Department ◽

Organ Donation ◽

Primary Outcome ◽

Organ Procurement ◽

Care Center ◽

Demographic Data ◽

Tertiary Care ◽

Solid Organ ◽

Organ Donors ◽

Organ Procurement Organization

Introduction: A significant gap exists between the number of people waiting for an organ and donors. There are currently 1,628 people awaiting organ donation in Ontario alone. In 2018 to date, 310 donors have donated 858 organs. The purpose of this study was to determine whether there were missed donors in the Emergency Department (ED) and by what percent those missed donors would increase organ donation overall. Methods: This was a health records and organ donation database review of all patients who died in the ED at a large academic tertiary care center with 2 campuses and 160,000 visits per year. Patients were included from November 1, 2014 – October 31, 2017. We collected data on demographics, cause of death, and suitability for organ donation. Data was cross-referenced between hospital records and the provincial organ procurement organization called Trillium Gift of Life Network (TGLN) to determine whether patients were appropriately referred for consideration of donation in a timely manner. Potential missed donors were manually screened for suitability according to TGLN criteria. We calculated simple descriptive statistics for demographic data and the primary outcome. The primary outcome was percentage of potential organ donors missed in the Emergency Department (ED). Results: There were 606 deaths in the ED from November 1, 2014 – October 31, 2017. Patients were an average of 71 years old, 353 (58%) were male, and 75 (12%) died of a traumatic cause. TGLN was not contacted in 12 (2%) of cases. During this period there were two donors from the ED and 92 from the ICU. There were ten missed potential donors. They were an average of 67 years, 7 (70%) were male, and 2 (20%) died of a traumatic cause. In all ten cases, patients had withdrawal of life sustaining measures for medical futility prior to TGLN being contacted for consideration of donation. There could have been an addition seven liver, six pancreatic islet, four small bowel, and seven kidney donors. The ten missed ED donors could have increased total donors by 11%. Conclusion: The ED is a significant source of missed organ donors. In all cases of missed organ donation, patients had withdrawal of life sustaining measures prior to TGLN being called. In the future, it is essential that all patients have an organ procurement organization such as TGLN called prior to withdrawal of life sustaining measures to ensure that no opportunity for consideration of organ donation is missed.

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The Reward is Worth the Wait: A Prospective Analysis of 100 Consecutive Organ Donors

The American Surgeon ◽

10.1177/000313481207800336 ◽

2012 ◽

Vol 78 (3) ◽

pp. 296-299 ◽

Cited By ~ 2

Author(s):

A. Britton Christmas ◽

Tyson A. Bogart ◽

Kristina E. Etson ◽

Brett A. Fair ◽

Harold R. Howe ◽

...

Keyword(s):

Patient Management ◽

Organ Procurement ◽

Prospective Analysis ◽

Organ Donors ◽

Donor Management ◽

Organ Procurement Organization ◽

Patient Demographics ◽

Included Patient ◽

Initial Hypothesis

Aggressive donor management protocols have evolved to maximize the number of procured organs. Our study assessed donor management time and the number and types of organs procured with the hypothesis that shorter management time yields increased organ procurement and transplant rates. We prospectively analyzed 100 donors managed by a regional organ procurement organization (OPO) during 2007 to 2008. Data included patient demographics, number and types of organs procured and transplanted, patient management time by the OPO, and achievement of donor pre-procurement goals. One hundred consecutive organ donors were managed with a mean age 41 ± 18 years and mean management time 23 ± 9 hours; 376 organs were procured and 327 successfully transplanted. Donors managed greater than 20 hours yielded significantly more heart (5 vs 26, P < 0.01) and lung (6 vs 40, P < 0.01) procurements, more organs procured per donor (3.2 ± 1.4 vs 4.2 ± 1.6, P < 0.01), and more organs transplanted per donor (2.6 ± 1.5 vs 3.7 ± 1.8, P < 0.01) than those managed 20 hours or less. No difference in the attainment of donor management goals was observed between these populations. Contrary to our initial hypothesis, donor management times greater than 20 hours yielded increased organ procurement and transplant rates, particularly for hearts and lungs, despite no differences in the achievement of donor preprocurement management goals.

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Breakdown in the Organ Donation Process and Its Effect on Organ Availability

Journal of Transplantation ◽

10.1155/2015/831501 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Manik Razdan ◽

Howard B. Degenholtz ◽

Jeremy M. Kahn ◽

Julia Driessen

Keyword(s):

Organ Donation ◽

Retrospective Analysis ◽

Poisson Regression ◽

Organ Procurement ◽

Strong Predictor ◽

Organ Donor ◽

Organ Procurement Organization ◽

Donation Process ◽

Organ Recovery ◽

Using Data

Background. This study examines the effect of breakdown in the organ donation process on the availability of transplantable organs. A process breakdown is defined as a deviation from the organ donation protocol that may jeopardize organ recovery.Methods. A retrospective analysis of donation-eligible decedents was conducted using data from an independent organ procurement organization. Adjusted effect of process breakdown on organs transplanted from an eligible decedent was examined using multivariable zero-inflated Poisson regression.Results. An eligible decedent is four times more likely to become an organ donor when there is no process breakdown (adjusted OR: 4.01; 95% CI: 1.6838, 9.6414;P<0.01) even after controlling for the decedent’s age, gender, race, and whether or not a decedent had joined the state donor registry. However once the eligible decedent becomes a donor, whether or not there was a process breakdown does not affect the number of transplantable organs yielded. Overall, for every process breakdown occurring in the care of an eligible decedent, one less organ is available for transplant. Decedent’s age is a strong predictor of likelihood of donation and the number of organs transplanted from a donor.Conclusion. Eliminating breakdowns in the donation process can potentially increase the number of organs available for transplant but some organs will still be lost.

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Hospital Characteristics Affect Consent and Conversion Rates for Potential Organ Donors

The American Surgeon ◽

10.1177/000313481708300421 ◽

2017 ◽

Vol 83 (4) ◽

pp. 354-358

Author(s):

Jawad T. Ali ◽

Aileen Ebadat ◽

Danilo Martins ◽

Sadia Ali ◽

Shannon Horton ◽

...

Keyword(s):

Organ Procurement ◽

The United States ◽

Organ Donors ◽

Trauma Centers ◽

Organ Procurement Organization ◽

Academic Hospitals ◽

Conversion Rates ◽

Level I ◽

Number Of Individuals ◽

Hospital Characteristics

Consent and conversion rates of potential organ donors in the United States need to be maximized to match the number of individuals awaiting organ donation. Studies to date have not focused on characteristics of centers with better outcomes. We performed an 8-year (2006–2014) retrospective study of our local organ procurement organization database. We categorized hospitals in our region as academic centers versus nonacademic centers, trauma centers versus nontrauma centers, and large (≥400 beds) centers versus small (<400 beds) centers. We also compared trauma centers with Level I designation to all other centers. Primary outcomes included consent and conversion rates for potential organ donors. There were 22,732 referrals to our organ procurement organization that resulted in 1,057 eligible deaths. When comparing academic to nonacademic hospitals, academic hospitals had higher consent (71% vs 59%, P < 0.0001) and conversion (73% vs 64%, P = 0.008) rates. Level I trauma centers had better consent and conversion rates when compared to all other hospitals, 73 versus 55 per cent and 76 versus 61 per cent respectively, P < 0.0001 for both. The small, academic, trauma centers had the highest consent and conversion rates, 77 and 78 per cent, respectively, P < 0.0001 for both. Hospital characteristics such as academic involvement, Level I trauma designation, and size impact consent and conversion rates for potential organ donors. Small (<400 bed), academic, trauma centers have the highest consent rates and conversion rates. Factors for success in these institutions should be examined and applied to assist in improving donor rates across all types of hospitals.

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The Role of the Organ Procurement Organization (DSO) in Coordinating Organ Donation in Germany and the Organ Donation Initiative Plan (Sponsor: Novartis Pharma GmbH, Nürnberg)

Therapieforum Transplant ◽

10.1055/a-1143-1465 ◽

2020 ◽

Vol 08 (01) ◽

pp. 20-23

Keyword(s):

Organ Donation ◽

Organ Procurement ◽

European Countries ◽

Organ Donors ◽

Organ Procurement Organization ◽

Deutsche Stiftung Organtransplantation ◽

Key Factor

AbstractOrgan donation in Germany started to decline in 2010 and dropped to a 20-year low of 797 organ donors in 2017. The rate of 9.7 organ donors per million population is far below donor rates in other European countries. The Deutsche Stiftung Organtransplantation (DSO, German Organ Procurement Organization) has been concerned about this development for many years and, in cooperation with German donor hospitals, has conducted extensive analyses to identify possible causes. While the causes are multifarious, the DSO sees the improvement of the identification and referral of potential organ donors in hospitals as a key factor in enhancing organ donation rates.

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Point-of-care testing in an organ procurement organization donor management setting

Clinical Transplantation ◽

10.1034/j.1399-0012.17.s9.9.x ◽

2003 ◽

Vol 17 ◽

pp. 48-51 ◽

Cited By ~ 7

Author(s):

K A Baier ◽

L E Markham ◽

S P Flaigle ◽

P W Nelson ◽

C F Shield ◽

...

Keyword(s):

Organ Procurement ◽

Point Of Care ◽

Point Of Care Testing ◽

Donor Management ◽

Organ Procurement Organization

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Increasing Referrals and Donations Using the Transplant Center Development Model

Journal of Transplant Coordination ◽

10.1177/090591999600600109 ◽

1996 ◽

Vol 6 (1) ◽

pp. 32-36 ◽

Cited By ~ 2

Author(s):

Mark T Gravel ◽

Penelope Szeman

Keyword(s):

Organ Donation ◽

Organ Procurement ◽

Medical Center ◽

Development Model ◽

Tissue Donation ◽

Staff Education ◽

Organ Procurement Organization ◽

Organ And Tissue Donation ◽

Transplant Center ◽

Donation Process

Although transplantation centers directly benefit from organ and tissue donation, they continue to yield low organ and tissue referral and donation rates. Our medical center and organ procurement organization developed a model to increase referral and donation rates. This model, called the Transplant Center Development Model, facilitates the donation process, specializes staff education, and promotes administrative involvement. After it was was implemented at our medical center in 1991, the referral and donation rates from 1988 to 1990 were compared with those from 1991 to 1993. The results showed that after implementation of the model, the organ referral mean increased 47%; the organ donation mean, 50%; and the tissue donation mean, 117%. These findings suggest that this model may be a valuable tool in transplant center development.

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Impact of Donation Physicians on Deceased Organ Donation: A Systematic Review

10.21203/rs.3.rs-200397/v1 ◽

2021 ◽

Author(s):

Janet E. Squires ◽

Laura D. Aloisio ◽

Wilmer John Santos ◽

Danielle Cho-Young ◽

Monica Taljaard ◽

...

Keyword(s):

Systematic Review ◽

Organ Donation ◽

Interrupted Time Series ◽

Deceased Donor ◽

Organ Donors ◽

Consent Rate ◽

Team Members ◽

Study Selection ◽

Before And After ◽

Deceased Organ Donation

Abstract Background: An emerging strategy to increase deceased organ donation is to use dedicated donation physicians to champion organ donation. We sought to conduct a systematic review of the effectiveness of donation physicians in improving organ donation outcomes.Methods: A systematic review was conducted following Cochrane principles. MEDLINE, Embase, and CINHAL databases were searched from inception to March 26, 2020. Quantitative studies examining the effects of donation physicians on all deceased organ donation outcomes were considered for inclusion. Review articles, editorials and opinion articles, and case studies were excluded. Study selection was completed independently by two team members; all discrepancies were resolved by consensus. Two team members independently extracted data from studies. Results: A total of 1,017 studies were screened, and 12 met inclusion criteria. Included studies were published between 1994 and 2019. Half used an interrupted time series design (n = 6; 50%), three (25%) were cohort studies, and three (25%) used a before-and-after study design. Outcomes (reported in greater than 50% of included articles) included consent/refusal rate (n = 8; 67%), number of potential donors (n = 7; 58%), and number of actual donors (n = 7; 58%). Across studies and design types, there was an increase in potential organ donors ranging from 8 to 143% (Mdn = 33%), an increase in actual organ donors from 15 to 113% (Mdn = 27%), an increase in donor consent rate from -3 to 258% (Mdn = 12%) and an increase in deceased donor transplants from 13 to 24% (Mdn = 19%) following the introduction of donation physicians.Conclusions: Donation physicians have the potential to significantly improve deceased organ donation. Further implementation and evaluation of donation physician programs is warranted. However, implementation should be undertaken with a clear plan for a methodologically rigorous evaluation of outcomes.

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