Donors Pmp Research Articles

A modified “spanish model” for organ donation in the southeast region of sweden

THE shortage of organ donors in the limiting factor for organ transplantation in Europe and North America. The organ donation rate in Sweden has been declining from about 16 donors per million inhabitants (pmp) in 1988 to fewer than 12 pmp in 1996, despite changes in the legislation and national information campaigns from the Swedish National Board of Health and Welfare. (In July 1996 a new law implementing presumed consent, donor cards, and a national donor registry was adopted.) Over the corresponding 10-year time period the organ donation rate in Spain increased from 14 donors pmp to 30. Spain has now the highest donor rate pmp in the world. The Spanish model includes the appointment of doctors (“Co-ordinators”), fullor part-time, with responsibility for the process of organ donation in each hospital with a potential for organ donation. Because of the declining donation rate we decided to implement parts of the “Spanish model” for organ donation locally in all hospitals as a project in Sweden’s southeast region.

A practical approach to evaluate the potential donor pool and trends in cadaveric kidney donation.

The potential supply of transplantable cadaver kidneys is often expressed as donors per million population (pmp), which ignores some essential factors governing organ donation. We performed a modeled analysis of kidney donor extraction rates by age, gender, race, cause of death, geographic region, and year in a cohort of evaluable deaths and actual cadaver donors between the ages of 1 and 65 years (1988-1993). Evaluable death was defined as an in-hospital death in patients between the ages of 1 and 65 years whose ICD-9-CM cause of death was not an obvious contraindication to kidney donation. The main outcome measures were the crude donation rate and an adjusted donor extraction rate (DER) per 1000 evaluable deaths. A total of 1.4x10(6) in-hospital deaths produced 300,502 evaluable deaths and 20,575 actual donors. Between 1989 and 1993, DER increased from 61.1 to 75 per 1,000 evaluable deaths. DERs were highest among the youngest age groups, declining significantly with age from 405.0 to 16.7/1,000 evaluable deaths for age groups 1-10 and 56-65 years, respectively. There was a small difference in donors pmp between blacks and whites (15 vs. 18). In contrast, DER was seven times higher in whites compared with blacks (112.5 vs. 16.5/1,000 evaluable deaths; P<0.001). The crude donation rate (per 1,000 evaluable deaths) was high for stroke (604.8) and trauma-related deaths (230.6), resulting in highly efficient donor extraction from these deaths. Region-specific DERs ranged from 49.4 to 83/1,000 evaluable deaths and differed significantly from the corresponding donors pmp. Estimating kidney donation relative to in-hospital evaluable deaths is a meaningful measure of organ procurement efficiency. Efforts to enhance cadaveric kidney donation should seek to understand and reduce the marked demographic and regional disparity in donor extraction rates.