Success of Another Hispanic Donation Model: The Puerto Rico Experience

Abstract

Introduction: The Spanish model for increasing organ donation has proven to be effective, based on the involvement of trained health care personnel in the care of potential donors and their families early in the process. This model has been applied in other countries also. Donation through an OPO was started in Puerto Rico in 1994 by LifeLink Foundation. Donors per million (dpm) have increased from an average of 3 (1994-7) to 28 (2007-11). Aim: To identify factors that have resulted in the significant increase in organ donors. Methods: Review of strategies, specific measures, changes implemented and significant events as they correlate with the number of donors per study period. Five time periods were identified according to the increment in number of donors. Results: For the initial period of 1994-97, aggressive public education, OPO-hospital contracts, recruitment of local executive director, and agreement with Medical Examiner were the main factors, resulting in average of 3 dpm. At this time, only kidney transplant was done in the island. From 1998-2000, dpm grew to 10.2. In this period, support from the federal and state governments, emphasis on brain death declaration, huge media exposure and a new heart transplant program were crucial. For 2001-3, 16.9 dpm were achieved. Staff growth, training of local kidney recovery surgeons, and endorsement by the Health Department were instrumental. From 2004-6, dpm rose to 22.5. Internal restructuring, uniform brain death protocol adopted by hospitals, identification and development of high donor potential hospitals, “Zero denial by ME” policy, training of local liver recovery surgeon, implementation of collaborative project with clinical triggers and management protocols, recruitment of critical care specialists for donor management, fulltime in-house public affairs specialist and active volunteer program were salient actions. The most recent growth to 28 dpm occurred from 2007-11. Measures included designated requestor, in-house coordinator, hospital standard support orders, Donor Advisory Committees, first responders, first kidney-pancreas transplant and implementation of electronic Donor Registry. Through out, a continued emphasis on physician education, brain death declaration and culturally sensitive public awareness campaign have been sustained. Conclusions: Creating a culturally sensitive process that includes highly trained DRs, focused education efforts, appealing public campaigns, addition of in-house coordinators, and development of local transplant centers have contributed to the increase in organ donors in spite of limited health care infrastructure and resources. Our experience supports the implementation of the Spanish approach of organizational strategies to increasing organ donation.