Donation Rates: What Matters?

Healthcare System Impact on Deceased Organ Donation and Transplantation: A Comparison Between the Top 10 Organ Donor Countries With 4 Countries in Southeast Asia

The need for organ donation is constantly increasing. Some countries have made improvements, while others, such as countries in Southeast Asia (SEA), have some of the lowest rates of deceased donors (pmp). This review aims to compare 14 countries with regards to many variables related to healthcare systems. Countries leading in deceased organ donation spend more on health and education, which is associated with increased potential for deceased organ donation. Out-of-pocket expenditure, is also associated with a decrease in deceased organ donation. Countries in SEA are lacking in healthcare resources such as workforce and materials, which are both necessary for a successful transplant program. Most countries in SEA have an excellent foundation for successful organ donation systems, including proper legislation, government support, and brain death laws along with an overall acceptance of brain death diagnosis. Priorities should include improving coordination, donor identification, and healthcare worker education. Countries in SEA have a lot of potential to increase deceased organ donation, especially by investing in healthcare and education. There is no one size fits all for organ donation programs and countries in SEA should focus on their strengths and take cultural differences into consideration when planning interventions.

Self-Assessment Tool and Clinical Audits: A Way to Manage Organ Donation and Transplantation in Hospital Settings

The self-assessment tool (SAT) of hospital management in donation and transplantation is a systematic instrument that allows reaching a situation status on Procurement and Transplantation with emphasis on the management and cultural change of Health Personnel in each care center. The SAT allows reflection on institutionalization, achievements, and the cultural change generated by donation and transplantation in Health Personnel. It also allows the evaluation of the culture of hospital donation and the formulation of plans and goals for the future. The SAT evaluates 5 components (Logistics, Education, Communication, Donation Culture, and Results Evaluation) with 30 questions and reflects the core aspects of the hospital donation process. The answers to the SAT are numbered and based on the total score. We can classify the management and its results as insufficient, basic, intermediate, and advanced. The SAT was applied in 8 hospitals whose donation results are externally audited, and their results were compared with the result of the self-assessment. The SAT was useful in supporting and guiding the work of the intra-hospital transplant coordinator; it allows the classification of the hospital, taking into account the main aspects of donation and transplant management and, based on this, generating a package of measures for improvement.

Donor heart selection: Evidence-based guidelines for providers

The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.

Organ Use Rate: A New Indicator of Donation and Transplantation Efficiency

The conversion rate has emerged as a good indicator of the effectiveness of the transplantation process by showing the percentage of potential donors who become real donors, but it overestimates the number of organs that are actually used for transplantation in recipients. The incorporation of organ use rate, a new quality indicator that reflects the actual number of organs used for transplantation excluding those that are discarded in the surgical block, provides complementary information of great value when comparing transplantation in different regions. This new variable allows more accurate prediction of the waiting time for the transplantation of a certain organ in patients with nonreversible organic insufficiencies, while providing the national authorities a real response in relation to the percentage of the demand for organs that can be satisfied.

Identifying opportunities to increase organ donation after brain death. An observational study in Sweden 2009-2014

BACKGROUND

There is a wide gap between the number of organ donors and patients on waiting lists for transplantation. The purpose of this Swedish nationwide study of the critical pathway for organ donation after brain death (DBD) was to identify missed opportunities for organ donation.

METHODS

We performed a prospective, observational study of all ICU deaths in Sweden from Jan 1, 2009 to Dec 31, 2014. The protocol structure followed the critical pathway for organ donation, which was developed and tested during 2008. We analysed differences in donation incidences between healthcare providers (counties) and patient characteristics using descriptive statistics and logistic regression.

RESULTS

The number of DBD per million population (pmp) was 14.9, varying almost 10-fold from 4.3 to 40.6 DBD pmp between counties. Regional variation in DBD decreased when we assigned the donor to the place of residence (from 6.9 to 27.7 DBD pmp). Women were more likely to become donors compared to men [crude odds ratio (OR) 1.60, 95% confidence interval (CI) 1.38-1.85, P < 0.001]. The increased likelihood remained after adjusting for age, comorbidity, and main diagnostic categories (OR 1.49, 95% CI 1.25-1.77, P < 0.001). An end-of-life decision was found in 50.9% of possible organ donors.

CONCLUSIONS

Regional differences in DBD were considerable, and women were more likely to become donors than men. There is a need for increased awareness of the potential for organ donation as an integral part of end-of-life clinical care. In-depth analysis of these differences may reveal opportunities for action that could lead to increased DBD.