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Rios-Diaz AJ, Olufajo OA, Stinebring J, Endicott S, McKown BT, Metcalfe D, Zogg CK, Salim A. Hospital characteristics associated with increased conversion rates among organ donors in New England. Am J Surg 2017; 214:757-761. [PMID: 28390648 DOI: 10.1016/j.amjsurg.2017.03.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 03/01/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND It is unknown whether hospital characteristics affect institutional performance with regard to organ donation. We sought to determine which hospital- and patient-level characteristics are associated with high organ donor conversion rates after brain death (DBD). METHODS Data were extracted from the regional Organ Procurement Organization (2011-2014) and other sources. Hospitals were stratified into high-conversion hospitals (HCH; upper-tertile) and low-conversion hospitals (LCH; lower-tertile) according to conversion rates. Hospital- and patient-characteristics were compared between groups. RESULTS There were 564 potential DBD donors in 27 hospitals. Conversion rates differed between hospitals in different states (p < 0.001). HCH were more likely to be small (median bed size 194 vs. 337; p = 0.024), non-teaching hospitals (40% vs. 88%; p = 0.025), non-trauma center (30% vs. 77%; p = 0.040). Potential donors differed between HCH and LCH in race (p < 0.01) and mechanism of injury/disease process (p < 0.01). CONCLUSION There is significant variation between hospitals in terms of organ donor conversion rates. This suggests that there is a pool of potential donors in large specialized hospitals that are not successfully converted to DBD.
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Affiliation(s)
- Arturo J Rios-Diaz
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Olubode A Olufajo
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School Brigham, Boston, MA, USA
| | | | | | | | - David Metcalfe
- Kadoorie Centre for Critical Care Research, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ali Salim
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School Brigham, Boston, MA, USA
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Caramiciu JA, Adams JP, McKown BT, French CD, Ruggieri ER, Heard SO. Effects of an in-house coordinator and practitioner referral rather than proxy referral on tissue donation rates. Transplant Proc 2015; 46:1274-80. [PMID: 24935289 DOI: 10.1016/j.transproceed.2014.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/11/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Timely referral of patients following asystolic death to an organ procurement organization (OPO) may increase tissue donation rates. Lack of education of health care providers and nonphysicians (admitting department) about timely referral to the OPO following asystolic death may adversely affect tissue donation rates. We hypothesized that using an in-house donation coordinator for provider education and changing the responsibility for calling the OPO from the admitting department to the licensed independent practitioner (LIP) declaring death would increase timely referral and tissue donation rates. METHODS An education program was developed in 2005 by a newly hired in-house coordinator to highlight the importance of tissue donation. In addition, to improve timely referrals to the OPO after death, the instructions accompanying the working copy of the death certificate were altered to require the patient's LIP to call the OPO within 1 hour of death (early 2007). Rates for both timely referrals and tissue donors were modeled by a Poisson regression model with a log link function. RESULTS Timely referral rates rose from 48% before the interventions to 72% after the intervention (P < .0001). The number of tissue donors per number of referrals also increased significantly (P = .025) over that period. CONCLUSIONS An in-house donation coordinator initiated education program and LIP referral rather than referral by other parties following asystolic death results in higher tissue donation rates.
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Affiliation(s)
- J A Caramiciu
- Department of Anesthesiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - J P Adams
- Department of Anesthesiology, University of Massachusetts Medical School, Worcester, Massachusetts; The New England Organ Bank, Waltham, Massachusetts
| | - B T McKown
- The New England Organ Bank, Waltham, Massachusetts
| | - C D French
- The New England Organ Bank, Waltham, Massachusetts
| | - E R Ruggieri
- Department of Mathematics, College of the Holy Cross, Worcester, Massachusetts
| | - S O Heard
- Department of Anesthesiology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
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