Article

Donor Conversion and Procurement Failure: The Fate of Our Potential Organ Donors

Division of Trauma and Surgical Critical Care, University of Southern California, 1200 North State Street, Room CL5100, Los Angeles, CA 90033-4525, USA.
World Journal of Surgery (Impact Factor: 2.35). 02/2011; 35(2):440-5. DOI: 10.1007/s00268-010-0870-0
Source: PubMed

ABSTRACT Donor availability remains the primary limiting factor for organ transplantation today. The purpose of this study was to examine the causes of procurement failure amongst potential organ donors.
After Institutional Review Board approval, all surgical intensive care unit (SICU) patients admitted to the LAC+USC Medical Center from 01/2006 to 12/2008 who became potential organ donors were identified. Demographics, clinical data, and procurement data were abstracted. In non-donors, the causes of procurement failure were documented.
During the 3-year study period, a total of 254 patients were evaluated for organ donation. Mean age was 44.8±18.7 years; 191 (75.2%) were male, 136 (53.5%) were Hispanic, and 148 (58.3%) were trauma patients. Of the 254 patients, 116 (45.7%) were not eligible for donation: 34 had multi-system organ failure, 24 did not progress to brain death and had support withdrawn, 18 had uncontrolled sepsis, 15 had malignancy, 6 had human immunodeficiency virus or hepatitis B or C, and 19 patients had other contraindications to organ donation. Of the remaining 138 eligible patients, 83 (60.2%) did not donate: 56 because the family denied consent, 9 by their own choice. In six, next of kin could not be located, five died because of hemodynamic instability before organ procurement was possible, four had organs that could not be placed, and three had their organs declined by the organ procurement organization. The overall consent rate was 57.5% (n=67). From the 55 donors, 255 organs were procured (yield 4.6 organs/donor).
Of all patients screened for organ donation, only a fifth actually donated. Denial of consent was the major potentially preventable cause of procurement failure, whereas hemodynamic instability accounted for only a small percentage of donor losses. With such low conversion rates, the preventable causes of procurement failure warrant further study.

Download full-text

Full-text

Available from: Bernardino Castelo Branco, Aug 16, 2014
0 Followers
 · 
113 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The shortage of post-mortem organ donors in the Netherlands is a prominent problem for patients on the waiting list for organ transplantation. As long as there is a shortage of suitable organs for transplantation, the need to identify bottlenecks in the organ donation process is crucial to further improve rates for donation. In comparison to other European countries the donation performance in the Netherlands is low. To get insight into the pool of potential organ donors’ medical records of patients who died on the intensive care unit were reviewed. The maximum number of potential organ donors appeared three times higher than the number of actual donors. The main reason for loss of potential donors was objection by relatives (~60% of all donor losses during the study period). We tried to compare our data to other studies. Unfortunately, because of the lack of uniform definitions, we had to conclude that numbers of potential donors and family refusal rates published in the reviews could not be used for a sound comparison between countries. To improve the possibility of learning from well-performing countries, we established a uniform definition of a potential heart-beating organ donor; ‘imminent brain death’. To reduce the number of family refusals we developed and implemented measures. We trained a special team of former or part-time intensive care nurses according to the ‘Communication about Donation’ programme. We named them ‘trained donation practitioners’ (TDP), and their role was to guide the family throughout the time they were present in the intensive care unit up to the point that a decision had been reached regarding organ and/or tissue donation. The family consent rate was significantly higher in the intervention hospital compared to two control hospitals. Therefore, we concluded that in the decision-making process appointing TDPs, who were highly dedicated to guide families from admittance to the ICU, resulted in higher family consent rates for donation.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Low donor supply and the high demand for transplantable organs is an international problem. The efficiency of organ procurement is often expressed by donor conversion rates (DCRs). These rates differ among countries, but a uniform starting point for defining a potential heart-beating donor is lacking. Imprecise definitions cause confusion; therefore, we call for a reproducible method like imminent brain death (IBD), which contains criteria in detail to determine potential heart-beating donors. Medical charts of 4814 patients who died on an ICU in Dutch university hospitals between January 2007 and December 2009 were reviewed for potential heart-beating donors. We compared two starting points: 'Severe Brain Damage' (SBD) (old definition) and IBD (new definition), which differ in the number of absent brainstem reflexes. Of the potential donors defined by IBD 45.6% fulfilled the formal brain death criteria, compared with 33.6% in the larger SBD group. This results in a higher DCR in the IBD group (40% vs. 29.5%). We illustrated important differences in DCRs when using two different definitions, even within one country. To allow comparison among countries and hospitals, one universal definition of a potential heart-beating donor should be used. Therefore, we propose the use of IBD.
    Transplant International 05/2012; 25(8):830-7. DOI:10.1111/j.1432-2277.2012.01505.x · 3.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite efforts to increase organ donation, there remain critical shortages in organ donors and organs procured per donor. Our trial is a large-scale, multicentre, randomised controlled trial in brain-dead donors, to compare protocolised care (using minimally invasive haemodynamic monitoring) with usual care. We describe the study design and discuss unique aspects of doing research in this population. Our study will randomise brain-dead patients to protocolised or usual care. The primary end point is the number of organs transplanted per donor. Secondary end points include number of transplantable organs per donor, recipient 6-month hospital-free survival time, and the relationship between the level of interleukin-6 and the number and usability of organs transplanted. The primary analysis will be an intention-to-treat analysis; secondary analyses include modified intention-to-treat and as-treated analyses. The study will also compare the ratio of observed to expected number of organs transplanted per donor, by treatment arm, as a secondary end point. Preplanned subgroup analyses include restriction to extended criteria donors, and donors older or younger than 65 years. Several unique challenges for study design and execution can be seen in our trial, and it should generate results that will inform and influence the fields of organ donation and transplantation.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2013; 15(3):234-40. · 2.15 Impact Factor
Show more