Evaluation of Strategies for Increasing Transplantation Should Be Based on a Current and Precise Assessment of the State of Organ Donation.

Abstract

To the Editor: In the article “Regional Differences in Communication Process and Outcomes of Requests for Solid Organ Donation,” Traino et al. (1Traino HM Molisani AJ Siminoff LA Regional differences in communication process and outcomes of requests for solid organ donation.Am J Transplant. 2017; 17: 1620-1627Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar) claim to “explore regional differences in communication in requests for organ donation.” However, old data and incomplete analysis make the conclusions of unclear value for furthering meaningful improvement in the field. The data underlying the article are more than 5 years old (2009–2012). Given that deceased organ donation in the United States has increased substantially, with a 20% increase in deceased organ donation over the most past 5 years (2012–2016), and in some regions this has well exceeded 50% in this same time-period (2United Network for Organ Sharing. [cited 2017 Jun 4]. Available from: https://www.unos.org/us-organ-transplants-set-record-in-2016/Google Scholar), it is difficult to draw supported conclusions about current regional differences based on old data. In addition, the data presented are not appropriately adjusted; the article states that United Network for Organ Sharing Region (UNOS) Region 5 accounted for 16.4% of deceased donor transplantations in 2015, while Region 6 accounted for only 3.4% (3Scientific Registry of Transplant Recipients. OPO Specific Reports. [cited 2017 Jun 4]. Available from: https://www.srtr.org/reports-tools/opo-specific-reports/Google Scholar). However, because the population is 54.1 million in Region 5 but only 15.2 million in Region 6, access to deceased-donor organ transplantation in these two regions is not dissimilar when properly indexed to population (4Organ Procurement and Transplant Network. National Data. [cited 2017 Jun 4]. Available from: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/Google Scholar). Furthermore, the article does not adequately address the increasing impact of first-person authorization on the overall donation service area authorization rates. Data from Donate Life America show that 46% of actual organ donations in 2014 and 2015 were preauthorized by the decedents themselves through the state donor registries (5Donate Life America. Annual Report. [cited 2017 Jun 4]. Available from: https://www.donatelife.net/wp-content/uploads/2016/06/DLA_AnnualReport_2016-low-res.pdfGoogle Scholar). Understanding the growing role of first-person authorization and identifying the underlying regional differences in donor registration rates of actual potential donors is important for evaluating the possible impact of proposed strategies such as the need for standardized Organ Procurement Organization staff training on requests. Increasing organ donation is a priority for the US health care system, and efforts to increase authorization rates through effective family approaches are important. However, a more current and precise assessment of the state of organ donation will provide the best foundation for truly understanding the impact of any one factor or proposed solution on the overall supply of organs for transplantation. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.