Changes in the solid organ donor pool and the effect on cardiothoracic donation?

Abstract

Background During the 1990’s the numbers of heart beating cadaveric solid organ and cardiothoracic donors have declined. Until recently fluctuations in the number of solid organ and cardiothoracic donors have mirrored each other. This study aimed to identify factors that influenced the probability of a solid organ donor donating cardiothoracic organs. Methods Data on 8442 adult heart beating cadaveric solid organ donors in the UK and Republic of Ireland during 1 January 1990 to 30 June 2000 were analysed. Logistic regression was used to assess the influence of donation year and zone, donor age, cause of death and blood group on the probability that a solid organ donor would become a cardiothoracic donor. Results In the first half of 1999 there were 344 solid organ and 129 cardiothoracic donors, this increased in the second half by 10% to 381and by 9% to 180, respectively. In the next 6 months solid organ donors remained stable, 379, but cardiothoracic declined by 10% to 162. In 1990 40% of solid organ donors provided cardiothoracic organs but this has steadily decreased to 34% in the first half of 2000. All factors investigated were found to be significant. Donors from road traffic accidents (RTAs) were more likely to donate cardiothoracic organs than those dying from cerebrovascular accidents (CVAs). Donor numbers from RTAs declined from 93 in the first half of 1990 to 43 in 2000 and from CVAs increased from 216 to 255. Proportionally fewer RTA donors provided cardiothoracic organs; 58% in 1990, 44% in 2000. Older solid organ donors were less likely to donate cardiothoracic organs than younger ones. Donors aged over 50 now constitute 19% of cardiothoracic donors compared with 2% in 1990. Conclusion Cardiothoracic organs are more likely to be retrieved from young RTA donors than any other group. This is a reducing donor pool as the median age of solid organ donors increases and fewer deaths occur from RTAs. Increased deaths from CVAs have recently helped maintain solid organ donor numbers but these donors are not always suitable as cardiothoracic donors due to the nature of their death.