Characteristics Of Organ Donors Research Articles

Organ donation by children in Australia, 2000-2019: impact of the 2009 National Reform Program. Apopulation-based registry data study.

To assess the impact of the 2009 National Reform Program for organ donation in Australia on the number and characteristics of organ donors under 16 years of age. Retrospective observational time series study; analysis of Australia and New Zealand Organ Donation (ANZOD) registry data for all consented potential deceased organ donors under 16 years of age during 2000-2019, and of numbers of donors aged 16 years or more reported in ANZOD annual reports. Difference between 2000-2008 (pre-reform) and 2009-2019 (reform period) in annual organ donor rates (donors per million population), by age group (under 16 years, 16 years or more), reported as incidence rate ratio (IRR). Differences in child donor characteristics during 2000-2008 and 2009-2019. During 2000-2019, 400 children under 16 years of age were consented potential deceased organ donors, of whom 374 were actual deceased donors (94%): 146 during 2000-2008, 228 during 2009-2019. The median annual rate was 3.3 (interquartile range [IQR], 3.0-4.3) actual donors per million population during 2000-2008 and 4.2 (IQR, 3.6-5.2) donors per million population during 2009-2019 (IRR, 1.15; 95% confidence interval [CI], 0.93-1.42). In contrast, the difference between the two periods was statistically significant for donors aged 16 years or more, rising from 11.7 (IQR, 11.2-11.8) to 19.9 (IQR, 18.3-24.4) actual donors per million population (IRR, 1.75; 95% CI, 1.66-1.85). The median age of actual organ donors under 16 was similar during 2000-2008 (11 years; IQR, 7-14 years) and 2009-2019 (10 years; IQR, 4-14 years), as was the proportion of donors in this age group under 10 kg (2000-2008: four of 146, 3%; 2009-2019: 14 of 228, 6%). Despite its overall effect on organ donation rates, the National Reform Program was not effective in increasing the numbers of donors under 16 years of age. Relying on broad initiatives for adult donors may not be appropriate for achieving this aim.

Characteristics of Organ Donors Who Died From Suicide by Hanging in Australia and New Zealand: A Retrospective Study.

Background and objectiveThe annual incidence of suicide by hanging in Australia and New Zealand has increased in the past decade, and a significant number of these individuals are becoming organ donors. The rates of organ donation following deaths from hanging is unknown and the characteristics of this cohort of donors have not been described in the literature. In light of this, we aimed to examine the trends in organ donation from individuals who had died from hanging, based on the solid organ donor data from the Australia and New Zealand Organ Donation (ANZOD) Registry.MethodsWe conducted a retrospective study that analyzed the ANZOD Registry donor data (2006-2015) to describe the characteristics of solid organ donors who had died by hanging (post-hanging group); these characteristics were compared to those of individuals who died by all other causes (non-hanging group).ResultsDuring the study period, the number and proportion of donors who died by suicide from hanging increased. Of the 4,024 consented organ donors, 226 had died by hanging and 3,798 had died from other causes. The probability that an individual who died by hanging would become an organ donor increased from 0.5 to 3%. Compared to donors who died by all other causes, post-hanging donors were younger (median age of 30 vs. 50 years), with fewer comorbidities, and a higher incidence of smoking. There was no significant difference in the proportion of those who indicated a prior intent to donate organs between post-hanging (34%) and non-hanging donors (38%). A higher proportion of post-hanging donors donated via the donation after the circulatory death pathway (36.3%) than non-hanging donors (24.2%). Individuals in the post-hanging cohort donated an average of 4.19 organs compared to 3.62 in the non-hanging cohort.ConclusionWe believe the findings of this retrospective analysis will help inform clinical decision-making regarding organ donation, including the best approaches to obtaining donation consent. Our findings will help physicians provide care to patients and to families of individuals in this challenging group, where organ donation potential is high. Further investigations are required to determine which aspects of healthcare influence the donation rates in individuals who have died by hanging and the outcomes related to transplanted organs.

49 Organ Donation Potential in Cases of Fatal Gunshot Wounds to the Head: Tools for Timely Screening in the Emergency Department

Gunshot wounds to the head (GSWH) have a high mortality rate and account for over a third of deaths due to head injury. Here we hypothesize that out-of-hospital vital signs may be useful tools in preliminary identification of organ donation potential when a patient presents to the ED with a fatal GSWH. Retrospective analysis was performed on data from an urban level 1 trauma center’s trauma database. All adult patients with out-of-hospital vital signs on-scene who presented to the ED before expiring due to a fatal GSWH between 1/1/2012 and 12/31/2018 were included. Characteristics of organ donors vs non-donors were analyzed, including injury severity score/abbreviated injury scale-head (ISS/AIS), on-scene Glasgow Coma Score (GCS), on-scene systolic blood pressure (SBP), on-scene respiratory rate (RR), and location of death. For non-normally distributed data, differences between groups were assessed with Wilcoxon Rank Sum Test. Differences for categorical variables were assessed using either Pearson's chi-squared test or Fisher's Exact Test. Significance noted when p < 0.05. Of 208 subjects meeting inclusion criteria, organ donation requests were made in 36 (17.3%) cases and 22 (10.6%) patients donated organs. Neither mean ISS nor AIS-head differed significantly between donors and non-donors (ISS: 4.5 vs 4.7 p=0.3761. AIS-head: 33.7 vs 27.3 p=0.0647) (Table 1). Donors had significantly higher mean on-scene GCS (5.1 vs 3.9 p=0.0016), SBP (129.3 vs 82.1 p=0.0028) and RR (20.5 vs 10.7 p=0.0001) than non-donors (Fig. 1A, B, C). While there was no significant difference in mean GCS at the ED (3.6 vs 3.5 p=0.4093), donors had a significantly larger decrease in mean GCS vs non-donors (-1.4 vs -0.6 p=0.0018) between on-scene and hospital assessment (Fig 1A). At the ED, donors had significantly higher mean SBP than non-donors (114.1 vs 82.7 p=0.0323) (Fig 1B). More donors than non-donors died in the ICU (90.9% vs 45.7%); 9.1% of donors and 45.7% of non-donors died in the OR; no donor died in the ED compared to 52.2% of non-donors; one non-donor (0.5%) died on the floor. Differences in location of death were significant (p < 0.0001) (Table 1). Out-of-hospital GCS, SBP, and RR values were all significantly higher in donors than non-donors. Donors also had significantly higher mean SBP at the ED and a larger decline in GCS between on-scene and the ED compared to non-donors. Nearly half of the study group, all non-donors, died in the ED. Out-of-hospital vitals and status changes en route to the ED may be of use in early identification of potential donors, allowing timely referral to organ procurement agencies, increasing donor opportunity and organ donation. No extra time or resources would be required to collect these metrics, as they are already assessed during emergent resuscitation and management of patients. Timely identification of donor potential may allow fatally wounded patients who expire in the ED the chance to become donors.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

P2.43: Impact of a new Nordic waiting list algorithm for patients awaiting intestinal transplantation in Sweden and Norway

Introduction: Since 1998, Swedish and Norwegian patients are transplanted in Gothenburg, Sweden. Initially, our institution managed the organ allocation of intestinal grafts for all patients. From 2010, due to a high mortality on the pediatric waiting list (WL) (70%), candidates were listed separately to increase awareness. From 2013 onwards, a joint Nordic shared waiting list (WL) was implemented for children listed for a liver transplantation and both pediatric and adult patients in need of an ITx; Herein, we describe and assess whether the change in WL algorithm implemented in 2010 has had an impact on WL dynamics for Swedish and Norwegian patients. Matreials and methods: Retrospective review of the Nordic Liver Transplant Registry. Variables studied: Comparison between (ERA 1: 1998–2010) and (ERA 2: 2011–2018). WL dynamics, organ donor characteristics, donor to recipient body weight ratio, cold ischemia time, mortality on the WL, proportion of grafts being shared between Swedish and Norwegian patients as well as the number of grafts imported from other Nordic and European countries. Results: 35 ITx have been performed in 34 patients; pediatric (9), adults (25). Isolated ITx (6) and MV grafts (29). Median time on the WL decreased when comparing ERA 1 and 2 but was not statistically significant (Table 1). Median waiting time for the pediatric recipients was longer than for the adults during both Eras. There were no mortalities on the WL after 2010. The proportion of grafts imported from other countries increased from 28% to 43% and the number of Swedish patients receiving grafts from other countries increased from 15% (n=3) to 33% (n=5). Eight Norwegian patients received 4 Swedish grafts and 4 Norwegian grafts. One isolated intestinal graft was harvested outside the Scandiatransplant procurement area (Switzerland). Conclusions: Changes in our Nordic waiting list policy appears to have shortened the waiting times, most notably for pediatric ITx candidates. No further mortalities on the WL occurred, but this may be attributed to other factors such as earlier referral for transplantation rather than changes in the shared waiting list. These data suggest an optimized utilization of the donor pool. Broadening the geographic procurement area may explain the longer cold ischemia times. Although many of the studied variables showed clear tendencies as mentioned above, they were not statistically significant. This may be due to the low number of observations.

Standard criteria donor pancreas donation status is associated with improved kidney transplant outcomes

Organ donor characteristics can be used to predict outcomes in kidney transplantation. We hypothesized that pancreas donation status could reflect organ quality and be predictive of kidney graft outcomes following Standard Criteria Donor (SCD) kidney transplantation. We performed a retrospective analysis of deceased donor kidney alone (DD KA) transplants reported to SRTR from 1992 to 2005. Group 1 = kidney alone recipients from pancreas donors (KA, P+) and Group 2 = kidney alone recipients from non-pancreas donors (KA, P-). We compared patient and graft survival between groups at 10-yr post-transplant. Group 1 (KA, P+) comprised 19 633 (20%) recipients and Group 2 (KA, P-) comprised 78 737 (80%) recipients. Ten-yr graft survival for Group 1 vs. Group 2 was 42.6% and 36.9% (p < 0.0001), respectively. Pancreas donation status (non-pancreas donor) was associated with a hazard ratio for graft loss of 1.23 on univariate analysis (p < 0.0001), and KA, P-remained an independent risk factor for graft failure at 10 yr, HR 1.09 (p < 0.0001). Donor pancreas donation status is an independent predictor of improved outcomes of SCD kidney recipients. Further study of the pancreas organ donor pre-procurement is warranted to optimize not only pancreas utilization but also kidney graft outcomes.

The potential organ donor pool: International figures

By understanding the size and characteristics of the potential donor pool, the concentration and location of the potential donors and factors influencing low rates of donation, it is possible to identify opportunities to improve the organ donation system. The exact donor gap needs to be established for each hospital/area, as published figures do not necessary reflect local potential. Nevertheless, marked differences with respect to the minimum standards in the number, location, and characteristics of organ donors should be considered as suggestive of low performance. The first stage where potential donors are lost is the detection of people who can be diagnosed as brain dead and, hence, could be considered a potential organ donor. Improving the donor identification implies the development of donor detection programmes. That and other initiatives to improve the donation rate need to be started in hospitals after the assessment of the local potential and local factors specifically implicated in the local performance.