Referral Of Potential Donors Research Articles

Results of a data-driven performance improvement initiative in organ donation.

New metrics for organ procurement organization (OPO) performance utilize National Center for Health Statistics data to measure cause, age, and location consistent (CALC) deaths. We used this denominator to identify opportunities for improved donor conversion at one OPO, Indiana Donor Network (INOP). We sought to determine whether such analyses are immediately actionable for quality improvement (QI) initiatives directed at increased donor conversion. CALC-based assessment of INOP's performance revealed an opportunity to improve conversion of older donors. Following the QI initiative, INOP donor yield rose by 44%, while organs transplanted rose by 29%. These changes tolerated temporary disruption around the COVID-19 pandemic. Improved donor yield was primarily seen in older groups identified by CALC-based methods. Process changes in resource allocation and monitoring were associated with a 57% increase in the number of potential donors approached in the QI period and a subsequent rise in the number of potential donor referrals, suggesting positive feedback at area hospitals. Post-intervention, INOP's projected donation performance rose from 51st to 18th among all OPOs. OPOs can use CALC death data to accurately assess donor conversion by categories including age and race/ethnicity. These data can be used in real time to inform OPO-level processes to maximize donor recovery.

Epidemiology and Comorbidity Burden of Organ Donor Referrals in Australia: Cohort Study 2010-2015.

Background.Increasing organ donation rates in Australia have been exceeded by a rise in potential donor referrals not proceeding to donate. Referral evaluation is resource-intensive. We sought to characterize organ donor referrals in New South Wales, Australia, and identify predictors of referrals not proceeding to donation.Methods.We performed a cohort study of NSW Organ and Tissue Donation Service logs 2010–2015, describing the prevalence and impact of comorbidities on referral outcome. Logistic regression was used to identify comorbidities influencing outcome and predict probability of donation.Results.Of 2977 referrals, 669 (22%) donated and 2308 (78%) did not. Despite increasing donation rates, the proportion proceeding to donate declined 2010–2015. Among referrals, the prevalence of all comorbidities except cerebrovascular disease increased and was higher among nondonors. History of cardiac disease, ≥65 years of age, chronic kidney or liver disease, malignancy, and absence of cerebrovascular disease were all significantly (P < 0.01) associated with non donation. Hypertension and diabetes did not significantly impact outcome. Predicted probability of donation varied from <1% to 54% depending on comorbidity burden of the referral.Conclusions.Comorbidity burden among donor referrals is increasing. The presence of particular comorbidities may significantly impact referral outcome. A better understanding of referral characteristics associated with non donation may improve the efficiency of the referral process in the context of encouraging routine referrals.

The Weekend Effect

Introduction A US study suggested donation rates were poorer on weekends. We investigated the effect of day-of-week of donor referral on organ donation in Australia. We also investigated whether any weekend effect resulted in fewer referrals for donation on weekends compared to weekdays. Methods In Australia, potential donor referrals are made to a state-based Donation Service, who then simultaneously seek family consent for donation and assess the medical suitability of the referral for donation. Referrals do not proceed without family consent, or if deemed medically unsuitable. In Australia, organ retrieval occurs when utilisation is almost certain, hence discard rates are extremely low. We retrospectively reviewed all New South Wales referral logs from January 2010 to March 2016. Our outcomes were actual donation (when a referral proceeded to organ retrieval), family consent, and medical suitability. We used logistic regression with random effects adjusting for clustering of referral hospitals. We used mortality data from the Australian Institute of Health and Welfare to compare donation referrals to the background mortality rate by day of the week. We compared donor referrals to all-cause mortality, and specifically to motor vehicle accident (MVA) deaths, as these deaths more typically result in donor referrals. Results Of 2,832 potential donors referred for consideration, 603 (21%) became actual donors.Donation rates were higher for weekend compared to weekday referrals (24% vs. 20%), however this was not statistically significant (p=0.1). We found no evidence of reduced donation (adjusted OR: 1.10; 95% CI 0.88 – 1.38; p=0.4), consent (adjusted OR 1.14; 95% CI 0.88-1.48; p=0.3), or medical suitability (adjusted OR 1.26; 95% CI 0.98-1.62; p=0.07) among weekend referrals.While all-cause mortality was relatively uniform over the week, referrals appeared to drop on Saturdays and Sundays.MVA deaths were more common on weekends (Saturday and Sunday), while the number of referrals from MVA deaths was relatively stable over the week.Compared to all-cause mortality rates by day of the week, the rate of donor-referral on weekends was lower than during the week (p<0.001). We also found that MVA referrals were less common on weekends compared to all MVA deaths (24% vs. 35%; p=0.03). Conclusion There was no association between day-of-the-week or weekend referrals and actual donation, family consent, or medical suitability. Our study suggests the Australian organ donation process is operating consistently even during transient periods of diminished resource or higher caseload, typically experienced during the weekend. These results stand in contrast to the findings from the US. There was some indirect evidence that donor referrals may be more selective at weekends. Further research could explore different stages of the donation pathway (e.g. progression from donor-identification to referral, and progression from actual donation to transplantation)

Socioeconomic factors as predictors of organ donation

BackgroundDespite numerous initiatives to increase solid organs for transplant, the gap between donors and recipients widens. There is little in the literature identifying socioeconomic predictors for donation. We evaluate the correlation between socioeconomic factors and familial authorization for donation. MethodsA retrospective analysis of adult potential donor referrals between 2007 and 2012 to our organ procurement organization (OPO) was performed. Potential donor information was obtained from the OPO database, death certificates, and the US Census Report. Data on demographics, education, residence, income, registry status, cause and manner of death, as well as OPO assessments and approach for donation were collected. End point was familial authorization for donation. ResultsA total of 1059 potential donors were included, with an overall authorization rate of 47%. The majority was not on the donor registry (73%). Younger donors (18-39 y: odds ratio [OR] = 4.9, P < 0.001; 40-60 y: OR = 2.1, P < 0.001), higher levels of education (college: OR = 2.5, P = 0.005; graduate studies: OR = 3.9, P = 0.002), prior listing on the donor registry (OR = 10.3, P < 0.001), and residence in counties with lower poverty rates than the US rates (OR = 1.7, P = 0.02) were independently associated with higher authorization rates. Decoupling (OR = 3.1, P < 0.001) and donation first mentioned by the local health care provider (OR = 1.8, P = 0.01) were also independently associated with higher authorization rates. ConclusionsDonor registration correlated most strongly with the highest authorization rates. These results indicate that public educational efforts in populations with unfavorable socioeconomic considerations may be beneficial in improving donor registration. Collaborations with local providers as well as OPO in-hospital assessments and approach techniques can help with improving authorization rates.

Improving Donor Conversion Rates at a Level One Trauma Center: Impact of Best Practice Guidelines

BackgroundOrgan availability is a consistently limiting factor in transplant surgery. A primary driver of this limitation is donor conversion rate, which is defined as the percentage of eligible donors for whom procurement is actually performed. An alternative way to increase organ availability is through improved utilization of organs from donors after cardiac death (DCD). Recently, a concerted, multidisciplinary effort has been made within our system to improve conversion rates and DCD utilization, thus increasing organ availability.Study designRetrospective analysis of a prospectively collected database from TransLife, our local organ procurement organization (OPO), as well as the Orlando Regional Medical Center (ORMC) trauma registry, from 2009-2012 (up to 2013 for DCD). During which time, this organization implemented best practice guidelines to improve conversions and DCD utilization. We analyzed yearly conversion rates, DCD donations and population demographics before and after implementation of these policies.ResultsDuring the study period, donor conversion rates significantly improved from 58% in 2009 to 82% percent in 2012 hospital-wide (P<0.05); and from 50% in 2009 to 81% in 2012 among trauma patients alone (P<0.05). In addition, total organs transplanted increased from 13 to 31 organs (P<0.05) after implementation of best practice guidelines. No significant differences in trauma population demographics were noted during the study period.ConclusionsBased on our experience, the establishment of best practice policies for referral of potential donors, coupled with programs to educate hospital staff on the existence and importance of these policies, leads to significant improvement in donor conversion rates and increased utilization of DCD donors.

Relationships Between Social Attitudes Toward Deceased Organ Donation and the Donation Rates in Poland, a Country With an Opting-out System.

Monitoring of attitudes toward deceased donation gives the general view of the acceptance of this treatment but does not allow for precise prediction of single person's behavior. Consistency of actions and attitudes has many determinants, personal and situational. The idea of this study was to assess and compare relationships between behaviors and attitudes toward postmortem organ donation in single districts and between larger regions of the country (west and east). Indicators calculated for the years 1996-2014 included the number of potential deceased donors (per million population [pmp]/y), the number of objections registered in the refusal registry (pmp), and the number and percentage of family refusals to donation. To assess relationships between variables, statistical and descriptive analyses were used. There were 10,731 potential donor referrals: 10 times more in the most active than in the least active province. Potential donor referrals from the western region were almost twice as high (18.3 pmp/y) as from the east (10.1). In 1,045 cases (9.7%), organs were not used owing to objections of the relatives; this index differed in each province up to 7-fold, but was almost the same in western and eastern regions. Total number of objections listed in the Refusal Registry was 28,725 (748 pmp). This index was different in each district up to 4-fold, but was not distinctly different in west and east regions. No distinct correlation (Pearson test) was found among the 3 assessed variables. Donation in Poland has much geographic differences. There is no common pattern of behavior and attitude toward donation and no correlation between these variables.

In-house coordination project for organ and tissue procurement: social responsibility and promising results.

Objectives: to report the results of evaluation regarding changes in the number of potential donor referrals, actual donors, and conversion rates after the implementation of an in-house organ and tissue donation for transplantation coordination project. Methods: epidemiological study, both retrospective and transversal, was performed with organ donation data from the Secretariat of Health for the State and the in-house organ donation coordination project of a beneficent hospital. The data was compared using nonparametric statistical Mann-Whitney test, and the Student's t-test, considering a significance level of 5% (p <0.05). Results: there were statistically significant differences (p < 0.05), before and after the implementation of the project on the number of potential donor notification/month (3.05 - 4.7 ), number of actual donor/month (0.78 to 1.60) and rate of conversion ( 24.7 to 34.8 %). The hospitals 1, 2, 7 and 8 had significant results in potential donor, actual donor or conversion rate. Conclusion: the presence of an in-house coordinator is promising and beneficial, the specialist is important to change the indicators of efficiency, which consequently reduces the waiting lists for organ transplants.

Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement.

Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement This consensus statement provides important guidelines for deceased donation to the transplant community. The document defines the standard of care for intensive care units regarding: (1) Definitions of death; (2) Timing and request for authorization; (3) Use of donors with malignancies and infections; (4) Testing for human immunodeficiency virus, hepatitis B and C; (5) Hemodynamic management; (6) Fluid resuscitation; (7) Vasoactive drugs; (8) Hemodynamic monitoring; (9) Endocrine dysfunction and hormone replacement; (10) Pediatric donor issues; (11) Specific organ management: heart, kidney, liver, lung and pancreas. The authors confirm the important impact that donation after circulatory determination of death (DCD) can make to increase the availability of organs. They highlight that liver and lungs can be used from selected DCD donors for transplantation. Clinicians must be prepared for potential DCD scenarios in which death does not occur within the established time after withdrawal of life-sustaining therapy: appropriate protocols should be in place to return the patient to a critical care setting for continuing care and to provide appropriate family support. The authors comment that intensive care unit caregivers and OPO representatives should provide all patients with equal opportunities for organ donation. One important recommendation is the early referral of potential donors to procurement agencies to increase the period available to evaluate a patient’s medical suitability for donation and to relay information to families in a manner that minimizes time pressure. The group recommends that OPO or designated coordinators with expertise should request authorization for organ donation in all institutions, using a collaborative approach with the rest of the healthcare team. There are several recommendations regarding malignancies and infections, but in general, risks of donor transmission must be weighed against risks for a potential recipient of not receiving the organ. Determinations about an individual donor’s medical suitability for organ donation should be made in conjunction with the local OPO and involved transplant centers. The authors recommend that patients with bacterial meningitis are suitable organ donors as long as they have received therapy directed against an identified or presumed pathogen while organ recipients get treated with a similar antibiotic regimen for 5 to 10 days. Organs should not be procured from patients with undiagnosed febrile illnesses, encephalitis, meningitis, or flaccid paralysis of unknown etiology. The use of nucleic acid amplification testing to detect the presence of human immunodeficiency virus RNA reduces the likelihood of unrecognized viremia by approximately half in all high-risk behavior categories; therefore, the use of nucleic-acid amplification testing was recommended for high-risk behavior groups. A frequent challenge for kidney and lung procurement is conflicting fluid requirements for the donor. Traditionally, aggressive fluid resuscitation and management were thought to result in improved procurement of kidneys, whereas a conservative fluid replacement strategy is thought to benefit the quality of lungs. The authors recommend a central venous catheter and/or pulmonary artery catheter to manage fluids: a combination of hormone replacement therapy and CVP-targeted fluid resuscitation should be the gold standard. Specific variables include a mean arterial pressure of 60 to 70 mm Hg, urinary output of 1 to 3 mL/kg per hour, a decrease in dose of vasoactive agents (dopamine ≤ 10 μg/kg per minute), and a left ventricular ejection fraction of at least 45%. Isotonic crystalloids and lactated Ringer are recommended as first line fluid management. Dopamine and arginine vasopressin replacement should be considered when hypotension persists despite adequate volume resuscitation. High-dose corticosteroid administration reduces the potential deleterious effects of the inflammatory cascade set in place subsequent to brain death. Ideally, steroids should be administered after blood has been collected for tissue typing as the expression of human leukocyte antigen may be suppressed. Thyroid replacement therapy—either alone or as part of a combination hormone therapy with intravenous arginine vasopressin, corticosteroids, and insulin—should be considered for hemodynamically unstable donors or for potential cardiac donors with abnormal (<45%) left ventricular ejection fraction. Specific aspects of death declaration for pediatric donors, including management goals are detailed in this report and differ from adult donors. Furthermore, organ-specific considerations are discussed in great detail—an extremely helpful tool in donor management and procurement.

Assessing Barriers to Organ and Tissue Donation in Australian Emergency Departments

Introduction: Organ and tissue donation (OTD) rates in Australia depend on healthcare professionals assessing donor eligibility, referring eligible patients, and discussing donation with the next of kin (NOK). Historically, OTD has not been a focus of emergency departments (EDs), however a missed potential donor pool was identified in EDs. Additionally, international data suggest that referral of potential donors from the ED increases successful organ retrieval compared to inpatient units including the intensive care unit (ICU). In recent years, the Australian Government has directed resources to improve OTD rates from EDs, and a nationally consistent clinical trigger tool was introduced in EDs to assist with early identification of potential donors. However, ED clinicians' perceived barriers to OTD are unknown. Methods: We undertook a cross-sectional national survey of members of the Australasian Colleges of Emergency Medicine (ACEM) and Emergency Nursing (CENA) to assess barriers to OTD in the EDs of Australia. This online survey was informed by available literature and included part of the Hospital Attitude Survey (DonorAction) and a validated brain death knowledge test (Tawil, 2009). Results: The response rate was 20%, comprising 599 doctors and 212 nurses. 25% of respondents had not received any education on OTD, which is voluntary, with ED clinicians from certain cultural and religious background less likely to have received education. Most (75%) had at least one experience with OTD related tasks in the previous year. Despite the roll-out of the national clinical trigger in 2010, only 60% of staff were familiar with this, and most were unsure which medical conditions preclude donor eligibility. Shortage of time and ED and ICU overcrowding were the main resource barriers reported. Knowledge of brain death was poor with only 59% of doctors and 63% of nurses passing a validated test. Of those not passing the test, more than 50% felt comfortable, and competent to explain brain death to the NOK. Moreover, of the 20% of all respondents who had explained BD to the NOK in the previous year, more than 35% failed the BD test. Most (86%) respondents agreed that brain death was a valid determination of death, and 90% reported willingness to donate organs and tissues after own death. While 90% supported OTD in general, only 70% supported OTD after cardiac death. Most (77%) indicated a desire for further education, with OTD after cardiac death, clinical management of a donor, and brain death the main topics of interest. Conclusion: The results of this survey present a comprehensive current overview of ED clinicians' perceived barriers to OTD organized from the ED. Our study raises concerns about the lack of knowledge about brain death, and lack of awareness of this deficit. To increase OTD referred from the ED, we propose that the topics identified in this study are included in ED postgraduate curricula. An increase in knowledge is likely to positively affect ED clinicians' attitudes, and increase potential donor referrals as well as family consent rates. This study was funded by the Australian Organ and Tissue Authority.

Interim Results of a National Test of the Rapid Assessment of Hospital Procurement Barriers in Donation (RAPiD)

Organ donation remains a major public health challenge with over 114 000 people on the waitlist in the United States. Among other factors, extant research highlights the need to improve the identification and timely referral of potential donors by hospital healthcare providers (HCPs) to organ procurement organizations (OPOs). We implemented a national test of the Rapid Assessment of hospital Procurement barriers in Donation (RAPiD) to identify assets and barriers to the organ donation and patient referral processes; assess hospital-OPO relationships and offer tailored recommendations for improving these processes. Having partnered with seven OPOs, data were collected at 70 hospitals with high donor potential in the form of direct observations and interviews with 2358 HCPs. We found that donation attitudes and knowledge among HCPs were high, but use of standard referral criteria was lacking. Significant differences were found in the donation-related attitudes, knowledge and behaviors of physicians and emergency department staff as compared to other staff in intensive care units with high organ donor potential. Also, while OPO staff were generally viewed positively, they were often perceived as outsiders rather than members of healthcare teams. Recommendations for improving the referral and donation processes are discussed.

Role of urgent care staff in organ donation

A detailed review of donation activity since the introduction of an embedded specialist nurse in organ donation (SNOD) in Norfolk and Norwich University Hospitals NHS Foundation Trust has confirmed the benefits of this role for the identification and referral of potential donors by emergency department (ED) staff. This article argues that, as EDs across the U.K. introduce SNODs, more organs will become available for transplant.

Implementing minimum notification criteria for organ donation in an acute hospital's critical care units

To increase the number of donated organs through an effective donor identification and referral scheme in a large acute hospital's critical care units. The barrier to successful organ transplantation is a serious shortage of donated organs. In January 2008, the Department of Health officially endorsed all 14 recommendations presented by the Organ Donation Taskforce. Recommendation 5 from the Taskforce is that minimum notification criteria for potential organ donation should be introduced on a UK-wide basis. A hospital policy entitled Required Referral was implemented into a large hospital trust consisting of four critical care units. Support from the trust board was sought and it was agreed that the policy would be implemented as a 'pilot policy' in the first instance, then a formal review after a 6-month period. A rolling education programme was instituted to incorporate 170 clinical staff to ensure the policy was activated with the following criteria: If the plan is to perform brain stem death tests on a patient or a clinical decision is made to withdraw treatment, the on-call donor transplant co-ordinator is contacted for an assessment of suitability. A significant increase in potential donor referrals and a 200% increase in donated organs has been achieved with the policy in place. A retrospective audit for the 6-month period prior to the policy launch had shown four referrals from the pilot sites. The following 12 months as the policy was implemented revealed an impressive 121 referrals to the transplant co-ordinator. This has resulted in nine successful multi-organ donors. The required referral scheme has clearly shown an impressive increase in donation activity within the trust. Donation has been embraced as a normal part of end of life care.

Impact of a Bereavement and Donation Service incorporating mandatory ‘required referral’ on organ donation rates: a model for the implementation of the Organ Donation Taskforce’s recommendations

In 2008 the Organ Donation Taskforce published its recommendations for increasing organ donation in the UK by 50% over 5 years. Bolton NHS Trust has addressed the problem of low rates of organ donation by amalgamating Bereavement and Donation Services and introducing a trigger to refer automatically all potential organ donors to the regional transplant donor co-ordinators. We audited the ability of the new service to deliver the aims and recommendations of the Organ Donation Taskforce. Following the changes in service provision the number of tissue donors rose from six in 2002 to 246 in 2007. In the same period solid organ donation rates remained unchanged. The introduction of an automatic trigger for referral of potential donors in 2007 resulted in 31 referrals and 11 successful multi-organ donors. The current service exceeds the aims of the Taskforce and offers the potential to meet UK organ donation targets without resorting to an 'opt out' system of presumed consent.

Culture Change Initiatives in the Procurement of Organs in the United Kingdom

In 2004, the United Kingdom began for the first time a systematic, countrywide initiative to increase organ donations. The approach, based on international research and with consultation from the United States, entailed encouraging the early identification and referral of potential donors, training critical care physicians in breaking bad news and in collaborating with donor coordinators, training coordinators in donation conversation skills, and getting them in to speak with families. The strategy represented a large culture change in the procurement of organs in the United Kingdom and has met resistance. However, the change has started to take hold and, despite a dramatic and unexpected 21% reduction in potential brain stem death donors over a 4-year period, is showing positive results. Herein we have described the historical model for procuring organs in the United Kingdom, the development of the new strategy, its components, and the results of its implementation, in terms of earlier referrals, the identification of non–heart-beating donors, the collaboration between physicians and coordinators in speaking with families and in converted donors.

Expanding the Donor Pool for Liver Transplantation in the Setting of an “Opt-out” Scheme – 3 years after New Legislation

The revised Human Organ Transplant Act (HOTA) was implemented in Singapore in July 2004. We aim to evaluate expanding the potential donor pool for liver transplant in Singapore with the inclusion of marginal donors. All donor referrals between July 2004 and June 2007 were studied. All potential deceased liver donors were heart-beating. After being reviewed by the transplant coordinator, potential donors were assessed by a transplant hepatologist and a transplant surgeon for suitability of organ donation strictly based on the programme's donor assessment protocol. Reasons for rejection as potential donors were documented. The clinical characteristics of all donor referrals were retrospectively reviewed, and an independent decision was made as to whether liver retrieval in each rejected case might have been possible. Among the 128 potential donor referrals, 20 donors (15.6%) underwent liver retrieval. Of the 20 livers retrieved, 16 were implanted and 4 were not implanted (3 unfit recipients, and 1 donor liver with 40% steatosis). Another 10 donor livers were assessed intraoperatively and were rejected because of varying levels of steatosis. Of these livers assessed, 5 donor livers had steatosis <40% and 5 had steatosis >40%. Of the remaining potential donors, 45 were deemed not possible because of prolonged hypotension (9), on-going or unresolved sepsis (13), high-risk behaviour (4), non-actualisation (8), or pre-existing medical conditions (11). Another 53 donors may potentially have been suitable donors but were rejected because of possible sepsis (13), no suitable recipients (12), transient hypotension (10), transient abnormal liver function test (6), history of alcohol ingestion (5), non-actualisation because of consent (4) and other reasons (3). Overall, it was deemed that 61 donors (47.7%) might potentially have been suitable liver donors. Despite new legislation (HOTA) in Singapore, the utilisation of cadaveric donor livers showed no increase in the last 3 years. By expanding our donor criteria to include marginal donors, we could potentially increase the availability of deceased donor livers to meet our waiting list demands.

Improving the Organ Transplantation Program in Greece: Institution of Local Transplant Coordinators’ Network

The success of a transplantation program depends upon the quality and effectiveness of the donation process, whereby the key role is assigned to the local transplant coordinator (TxC). This important professional figure was only recently established in Greece. The local TxC duties were outlined alongside those of the Hellenic Transplant Organization (HTO) foundation in 1999, whereby three different transplant coordinator positions—central, local, and clinical—were specified. In 2002, the above-mentioned positions were legally consolidated. Local TxCs had to be doctors or nurses, in a 70%-30% ratio, already working in intensive care unit (ICU) and had to be appointed by the hospital and ICU directors in each hospital as requested by the HTO. By the end of 2004, this network consisted of 122 TxCs located in 74 ICUs, especially trained in donation procedures and ethics. Half of the doctors were ICU directors, especially appointed to influence ICU personel. Furthermore in 2005, the board of directors of HTO decided that there should be closer cooperation between the 45 most donor generating ICUs and their TxCs. It was decided that the local TxCs would work part-time and receive a monthly grant. The 45 ICU network started in 2005, resulting in an 154% increased rate of potential donor referrals and a 33% and almost 38% increase in actual donors and transplantations, respectively, compared to 2004. This substantial increase was achieved by the institution of TxC network.

Timely Referral of Potential Organ Donors

Timely Referral of Potential Organ Donors

Organ Donation Breakthrough Collaborative

Organ Donation Breakthrough Collaborative

Improving donor identification with the Donor Action programme

Abstract The increasing demand for organs for transplantation entails a consensual need for enhancement of organ procurement activity. As organ donors reside mainly in hospital intensive care units (ICUs), the Donor Action programme is aimed at identifying critical areas in ICUs, in order to improve the first step of organ donation. The purpose of this paper is to analyse the problem of identification of potential donors by means of a chart revision of patients who died in 14 ICUs in the Emilia-Romagna region between 1 July 1998 and 31 December 2000. All deaths and patients with severe brain insult (score on Glasgow Coma Scale (GCS) = 3/15) were assessed by the local transplant co-ordinators together with a professional at the Transplant Reference Centre. Brain death diagnoses and potential donor referrals were therefore assessed in the study period, which was subdivided into five semesters. Of the 3,056 deaths reported in 30 months, 1,248 were due to severe brain damage (GCS score = 3). Brain death diagnosis (BD) was performed in 509 patients (40.8%). Although we applied the same parameters over the whole length of the study, we observed a significant increase in BDs (from 87 in the first semester to 125 in the last, 30.5% to 53.0% of the patients with GCS 3 (P= 0.003, χ2 for trend = 16.072), in spite of a slight decrease in the total number of deaths and in the total number of patients with GCS score = 3 (from 649 to 587, and from 44% to 41%, respectively). Study population characteristics could have contrasted with rather than facilitated our results: age and gender did not change significantly, whilst cause of death showed a significant reduction in trauma and an increase in cerebro-vascular incidents over the whole length of the study. We can conclude that the more careful assessment of patients dying in ICUs, by the Donor Action programme, significantly contributed to the improvement of BDs observed in the study period. Therefore, Donor Action seems to be an efficient quality control programme to improve identification of potential donors, the first stage of organ procurement.

Improving donor identification with the Donor Action programme.

The increasing demand for organs for transplantation entails a consensual need for enhancement of organ procurement activity. As organ donors reside mainly in hospital intensive care units (ICUs), the Donor Action programme is aimed at identifying critical areas in ICUs, in order to improve the first step of organ donation. The purpose of this paper is to analyse the problem of identification of potential donors by means of a chart revision of patients who died in 14 ICUs in the Emilia-Romagna region between 1 July 1998 and 31 December 2000. All deaths and patients with severe brain insult (score on Glasgow Coma Scale (GCS) = 3/15) were assessed by the local transplant coordinators together with a professional at the Transplant Reference Centre. Brain death diagnoses and potential donor referrals were therefore assessed in the study period, which was subdivided into five semesters. Of the 3,056 deaths reported in 30 months, 1,248 were due to severe brain damage (GCS score = 3). Brain death diagnosis (BD) was performed in 509 patients (40.8%). Although we applied the same parameters over the whole length of the study, we observed a significant increase in BDs (from 87 in the first semester to 125 in the last, 30.5% to 53.0% of the patients with GCS 3 ( P=0.003, chi(2) for trend=16.072), in spite of a slight decrease in the total number of deaths and in the total number of patients with GCS score = 3 (from 649 to 587, and from 44% to 41%, respectively). Study population characteristics could have contrasted with rather than facilitated our results: age and gender did not change significantly, whilst cause of death showed a significant reduction in trauma and an increase in cerebrovascular incidents over the whole length of the study. We can conclude that the more careful assessment of patients dying in ICUs, by the Donor Action programme, significantly contributed to the improvement of BDs observed in the study period. Therefore, Donor Action seems to be an efficient quality control programme to improve identification of potential donors, the first stage of organ procurement.