Number Of Potential Donors Research Articles

Organ donation performance in the Netherlands 2005-08; medical record review in 64 hospitals

The Netherlands has a low number of deceased organ donors per million population. As long as there is a shortage of suitable organs, the need to evaluate the donor potential is crucial. Only in this way can bottlenecks in the organ donation process be detected and measures subsequently taken to further improve donation procedures. Within a time frame of 4 years, 2005-08, medical charts of all intensive care deaths in 64 hospitals were reviewed by transplant coordinators and donation officers. Data were entered in a web-based application of the Dutch Transplant Foundation, both to identify the number of potential organ donors (including donation after cardiac death), as well as to analyse the reasons for potential donor loss. In total, 23 508 patients died in intensive care units, of which 64% were younger than 76 years. The percentage of all potential organ donors out of the total number of deaths decreased from 8.2% in 2005 to 7.1% in 2008. Donor detection increased from 96% in 2005 to 99% in 2008. Of the potential donors, 17-21% recorded consent and 17-18% recorded objection in the national Donor Register. If the Donor Register was not decisive, the consent rate of families approached for organ donation was 35% in 2005, 29% in 2006, 41% in 2007 and 31% in 2008. The overall conversion rate (the number of actual donors divided by the number of potential donors) was 30%, 26%, 35% and 29% in these years. In the group of potential donor losses, objection by families accounted for about 60% during this study. This study showed that the maximal number of potential organ donors is about three times higher than the number of effective organ donors. The main reason accounting for approximately 60% of the potential donor losses was the high family refusal rate. The year 2007 showed that a higher percentage of deceased organ donors can be procured from the pool of potential donors. All improvements should focus on decreasing the unacceptably high family refusal rates.

Organspendebereitschaft: Auswertung einer Umfrage zu Gesundheitsthemen

Currently, organ transplantation is the treatment of choice for patients with chronic or acute organ failure. However, due to a lack of donor organs, every day three patients die on the waiting list for transplantation. At the same time there is a high potential of organ donors that is not utilized. Statements concerning the number of potential donors are possible only to a limited extent at present. Objective of this study was to collect the rate of holders of organ donor cards among the employees of the city of Essen before a targeted awareness raising campaign had been carried out. A questionnaire was sent out to the employees of the city of Essen in 2007. Gender, age and the "indicator for readiness for organ donation" were stratified and analyzed according to the holding of organ donor cards. The indicator reflects the evaluation of health awareness in the respondents. Altogether, 1 814 questionnaires were evaluated. 20 % of the respondents were holding an organ donor card at the time of the survey. No association between gender (p-value 0.17) respectively age (p-value 0.79) and the possession of an organ donor card could be detected. 23 % of the respondents who regularly worked out or donated blood were identified as organ donor card holders. This is significantly more (p-value < 0.0001) than in respondents where this criterion did not apply. In order to optimize the potential of organ donors in the long term, it is necessary to reconsider and advance attitude towards the readiness for organ donation. Further spreading of information and education as well as transparency in the transplantation medicine are essential for this project.

Pretransplant Genetic Testing of Live Kidney Donors at Risk for Autosomal Dominant Polycystic Kidney Disease

Pretransplant Genetic Testing of Live Kidney Donors at Risk for Autosomal Dominant Polycystic Kidney Disease

No room for cancellation, coasting, or ovarian hyperstimulation syndrome in oocyte donation cycles

We retrospectively studied 429 IVF donor cycles in which ovulation was triggered with either hCG (175 cycles) or GnRH agonist (254 cycles). Of the donors in whom ovulation was triggered with hCG, 3.2% developed symptoms of moderate (2.2%) or severe (1%) ovarian hyperstimulation syndrome, while none of the IVF donor cycles that were triggered with the GnRH agonist presented ovarian hyperstimulation syndrome, needed coasting, or were cancelled.

A student-led programme to raise awareness of organ donation

O rgan transplantation is described as ‘medicine of the twenty-first century’ and remains the most effective long-term treatment for end-stage kidney, liver, heart and lung failure. As the demand for solid organ transplants increases on an annual basis, the number of potential donors has failed to keep up with demand and has remained constant over the last decade. Moreover, 400 people die every year in the UK while waiting for a kidney transplantation because of the shortage of donor organs.

Improving Consent Rates for Organ Donation: The Effect of an Inhouse Coordinator Program

The inability to obtain consent remains one of the major obstacles to organ donation. The presence of in-house coordinators (IHCs) from organ procurement organizations (OPOs) might substantially improve donation rates. To review the preliminary results of the effect of the presence of an IHC on organ donation rates at our center. This is a retrospective analysis of patients referred to the regional OPO for possible organ donation. An IHC program was started at our hospital in late 2001. Data regarding organ donation demographics and family consent rates were compared before (Pre-IHC, 1998-2001) and after (Post-IHC, 2002-2005) the institution of an IHC program. The conversion rate was calculated as the number of actual donors divided by the number of potential donors and is represented as a percentage. The function of the IHC was to assist in donor surveillance, ensure timely referral, provide hospital staff education, assist with family consent and donor management, and provide family support. There were a total of 495 potential donors and 195 actual donors during the 8-year time period. Post-IHC was associated with a significantly higher consent rate (52% vs. 35%, p < 0.01), a significantly higher conversion rate (50% vs. 34%, p < 0.01), and a 17% increase in organs donated compared with Pre-IHC. The presence of an IHC program significantly improves consent and conversion rates for organ donation. An IHC program should be considered as a viable option to bridge the gap between organ supply and organ demand.

276: Teaching on postoperative day one: A feasible approach to reduce length of stay in ventricular assist device patients

following bereavement and is primarily the decision of the potential donor’s next of kin. Recent UK legislation may transfer the timing and primacy of this decision to the donor who may have registered advance intentions to donate on a national register. We hypothesised that postive televison media coverage of heart transplantation may affect the potential donor registration rate. Methods and Materials: We examined web-based requests to register on the UK Organ Donor Register between January 2005 and August 2006. Changes in registration numbers were compared according to media coverage events. Results: In the 20 month period there were 286,207 registration requests and 5 transplant topic television items. The mean registration rate was 14,310( 95%, CI 9951-18,668) per month. The number of registrations in months following media coverage were significatly higher than in those without (20,904(95% CI 11,115-30,694) versus 9,864(95%CI8047-681) p 0.006).The observed effect appeared greatest when a heart transplant related topic arose in a fictional “soap opera” with a high viewing audience compared to non-fictional coverage but this was not significant(p 0.27). This apparent effect of positive coverage was short lived. Registration rates fell to the previous baseline within a month of coverage. The greatest increase in registration was seen on the day of broadcast( 2.8 times previous rate). This enhanced rate halved within 24 hours. Conclusions: Positive media coverage increases advance registration rates to a National Donor Register. The effect is short lived and may be insufficient to change rates of actual transplantation. Nevertheless, such coverage together with other educational initiatives may increase the number of potential donors for consideration of transplantation.

Timely Referral of Potential Organ Donors

Timely Referral of Potential Organ Donors

Estimating the Organ Donor Potential in Denmark: A Prospective Analysis of Deaths in Intensive Care Units in Northern Denmark

To estimate the organ donor potential in Denmark we conducted a prospective registration of deaths in all intensive care units (ICUs), counting 15 ICUs and two neurosurgical ICUs in the four northern Danish counties, which cover a population of 1.64 million inhabitants or 30% of the Danish population. From September 1, 2000 till August 31, 2002, all deaths in the ICUs in 15 hospitals were recorded. Each case was evaluated locally postmortem with respect to medical suitability to organ donation. A total of 1655 deaths were recorded, corresponding to 504 deaths per million population per year (PMP). Median age was 70 years (0 to 99 years), 52% were more than 70 years, and 22% more than 80 years of age. The cause of death was cerebral lesion in 18% of the cases (neurosurgical ICUs: n = 182; ICUs: n = 110). By thorough medical record examination, the number of potential donors was estimated to be 169, corresponding to 51 PMP. The cause of death was cerebral lesion in 96% of the potential donors. Organ donation was performed in 43 cases (32 from neurosurgical ICUs and 11 from ICUs) or 13.1 PMP. Thus, 25% of the potential became organ donors. The major reason for nondonation was refusal from the relatives. Out of 127 questioned, the relatives refused in 62 cases (49%). By comparison, 74% of the general Danish population are willing to donate organs after death. The rate of nondetection of potential donors by the hospital staff could be estimated to 22%. In conclusion, the organ donor potential may allow for improvement in donation rates. An increased effort for donor hospitals is warranted. The motives for refusal by the relatives need elucidation.

Estimating the number of potential organ donors in the United States.

As the need for transplantable organs increases, waiting lists of patients become longer. We studied the size and composition of the national pool of brain-dead organ donors during a three-year period and, on the basis of these data, considered ways to increase the rate of donation. We reviewed hospital medical records of deaths occurring in the intensive care unit from 1997 through 1999 in the service areas of 36 organ-procurement organizations to identify brain-dead potential organ donors. We examined data on characteristics of the potential donors, the processes of referral to organ-procurement organizations and of requesting donations, and the hospitals. We identified a total of 18,524 brain-dead potential organ donors during the study period. The predicted annual number of brain-dead potential organ donors is between 10,500 and 13,800. The overall consent rate (the number of families agreeing to donate divided by the number of families asked to donate) for 1997 through 1999 was 54 percent, and the overall conversion rate (the number of actual donors divided by the number of potential donors) was 42 percent. Hospitals with 150 or more beds were more likely than smaller hospitals to have potential donors and actual donors (P<0.001); 19 percent of hospitals accounted for 80 percent of all potential donors. Calculations of the number of donors per million persons in the general population did not correlate well with the performance of organ-procurement organizations as measured by the conversion rate. Lack of consent to a request for donation was the primary cause of the gap between the number of potential donors and the number of actual donors. Since potential and actual donors are highly concentrated in larger hospitals, resources invested to improve the process of obtaining consent in larger hospitals should maximize the rate of organ recovery. The performance of organ-procurement organizations can be assessed objectively through the comparison of the number of actual donors with the number of potential donors in the given service area.

Increasing the Donor Pool in Chile

The purpose of this study was to evaluate organ donation in Chile following the creation of the “Corporación Nacional de Fomento de Trasplantes.” The corporation was created in 1991 as a private, nonprofit organization whose main purpose was to increase the number of actual donors and multiorgan procurement. The organization is independent of the national government and acts as a link between the needs of patients and society and those of the national ministry of health. Following the creation of the corporation, the number of actual donors increased from 32 to 98. The number of potential donors increased 3-fold. Family refusal for organ donation was between 28% and 53.4%. Pediatric and marginal donors increased from 2% to 15%. Ninety-five percent of the donors came from Santiago, where 33% of the population lives and most of the efforts were concentrated. The corporation is working to increase organ donation throughout the rest of the country by organizing public campaigns; promoting knowledge about transplantation among medical and nursing personnel at hospitals, schools, universities, and social gatherings; evaluating technical and financial results; and helping with the processes of organ procurement.

Analysis of donor selection procedure in 139 living-related kidney donors and follow-up results for donors and recipients

In 1981 an active programme was started in our centre for living-related kidney donation (LRD). The structure of this LRD programme is described in this paper. Retrospectively the results of this LRD programme were studied. Between 1981 and 1988 139 potential living donors were evaluated. Of all potential donors 47 (34%) actually donated a kidney, including 24 HLA non-identical combinations. Follow-up was obtained until 1990. An acceptable incidence of morbidity and mortality for donors and recipients was observed. A high number of potential donors was excluded during the selection procedure (66%). They were often refused for medical reasons (29%), with a high incidence of renal dysfunction (16%). No long-term adverse effects of nephrectomy regarding decreased renal function, hypertension, or proteinuria were seen. Of all actual donors 23% experienced minor complications after donation. Living-related kidney transplants showed better graft function than cadaveric grafts.

Organ and tissue donation from the emergency department

Despite mandatory request legislation, the lack of available donor organs and tissues continues to limit transplant efforts. The potential contribution from emergency department (ED) patients remains undefined. We reviewed the charts of patients dying in our ED for organs and tissues potentially suitable for transplantation, age, cause of death, and physician documentation of donation inquiry. Of 155 charts reviewed, potential donors were identified for corneas (99), bones (61), heart valves (42), and kidneys (3). Of the 155 charts, 130 (84%) made no mention of donation, and of 37 charts containing a donor request form, 34 (92%) were incorrectly filled out or left blank. Four charts (2.6%) mentioned donation in the narrative section, two (1.3%) documented discussion with family, and one patient was referred to our Organ Procurement Organization, with recovery of one kidney and heart valves. We conclude that physicians rarely document consideration of donation for patients dying in the ED; the number of potential donors far exceeds the number referred or recovered. Future efforts should focus on methods to increase recognition and referral of organ and tissue donors from the ED.

ORGAN AND TISSUE DONATION FROM THE EMERGENCY DEPARTMENT

Despite mandatory request legislation, the lack of available donor organs and tissues continues to limit transplant efforts. The potential contribution from emergency department (ED) patients remains undefined. We reviewed the charts of patients dying in our ED for organs and tissues potentially suitable for transplantation, age, cause of death, and physician documentation of donation inquiry. Of 155 charts reviewed, potential donors were identified for corneas (99), bones (61), heart valves (42), and kidneys (3). Of the 155 charts, 130 (84%) made no mention of donation, and of 37 charts containing a donor request form, 34 (92%) were incorrectly filled out or left blank. Four charts (2.6%) mentioned donation in the narrative section, two (1.3%) documented discussion with family, and one patient was referred to our Organ Procurement Organization, with recovery of one kidney and heart valves. We conclude that physicians rarely document consideration of donation for patients dying in the ED; the number of potential donors far exceeds the number referred or recovered. Future efforts should focus on methods to increase recognition and referral of organ and tissue donors from the ED.

The Organ Donor

Vascularized organ transplantation is now a widely applied therapy for patients with end-stage diseases of the heart, lungs, liver, kidneys, and pancreas. A critical shortage of donor organs exists in the United States and, as a consequence, prospective transplant recipients die while waiting for a life-saving transplant. The apparent shortage of cadaver organs is, in large part, caused by the reluctance and failure of the physician and the public to promote cadaver organ donation. Educational awareness programs for both professional personnel and the public at large are needed to increase the number of potential donors and multiorgan procurements carried out. All victims of trauma with severe closed head injury or cerebrovascular catastrophe secondary to anoxia should be considered as potential organ donors and referred to the local organ procurement agency for evaluation.

Presumed consent for organ retrieval.

There remains a tremendous shortage of organs for transplantation, and many patients have prolonged waiting periods before receiving a transplant. This occurs in spite of data showing that (1) the general public supports transplantation and organ donation, and (2) a much larger number of donors is potentially available. Current legislation creates an environment that is awkward and often hostile to organ donation. As a result, many physicians do not refer potential donors and many families refuse consent. Presumed consent legislation would create a more favorable environment and has the potential of markedly increasing the number of potential donors whose organs could be used. Arguments against changing the law to ‘presumed consent’ have emphasized that other remedies would increase the number of donors. However, these remedies have been in effect for almost two decades without a marked increase in organ donation. We recommend reconsideration of legislative changes to enable ‘presumed consent’ to be in force.

Public attitudes towards kidney transplantation.

A representative sample of 500 members of the public was interviewed about kidney transplantation. The survey showed that despite widespread awareness of the need for kidney donors only 4.4% of the respondents had completed a donor card. The small percentage holding kidney donor cards appears to reflect a failure to inform and motivate the general public. There was no evidence of any widespread objection to the procedures involved in obtaining cadaver kidneys, but there was strong objection to the introduction by law of an "opting out" system. The findings suggest how the numbers of potential donors could be increased without changing the law as regards consent to donation.