ContextTransplantation has become the therapy of choice for patients with organ
failure. However, the low rate of consent by families of donor-eligible patients
is a major limiting factor in the success of organ transplantation.ObjectiveTo explore factors associated with the decision to donate among families
of potential solid organ donors.Design and SettingData collection via chart reviews, telephone interviews with health
care practitioners (HCPs) or organ procurement organization (OPO) staff, and
face-to-face interviews with family for all donor-eligible deaths at 9 trauma
hospitals in southwestern Pennsylvania and northeastern Ohio from 1994 to
1999.ParticipantsFamily members, HCPs, and OPO staff involved in the donation decision
for 420 donor-eligible patients.Main Outcome MeasureFactors associated with family decision to donate or not donate organs
for transplantation.ResultsA total of 238 of the 420 cases led to organ donation; 182 did not.
Univariate analysis revealed numerous factors associated with the donation
decision. Multivariable analysis of associated variables revealed that family
and patient sociodemographics (ethnicity, patient's age and cause of death)
and prior knowledge of the patients' wishes were significantly associated
with willingness to donate (adjusted odds ratio [OR], 7.68; 95% confidence
interval [CI], 6.55-9.01). Families who discussed more topics and had more
conversations about organ donation were more likely to donate (adjusted OR,
5.22; 95% CI, 4.32-6.30), as were families with more contact with OPO staff
(adjusted OR, 3.08; 95% CI, 2.63-3.60) and those who experienced an optimal
request pattern (adjusted OR, 2.96; 95% CI, 2.58-3.40). Socioemotional and
communication variables acted as intervening variables.ConclusionsPublic education is needed to modify attitudes about organ donation
prior to a donation opportunity. Specific steps can be taken by HCPs and OPO
staff to maximize the opportunity to persuade families to donate their relatives'
organs.

/pdf/factors-influencing-families-consent-for-donation-of-solid-1zoxqxfqja.pdf

Factors Influencing Families' Consent for Donation of Solid Organs for Transplantation

background 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. methods 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. results 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. conclusions 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.

https://www.nejm.org/doi/pdf/10.1056/NEJMsa021271

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

We evaluate the introduction of monetary incentives in the market for live and cadaveric organ donations. We show that monetary incentives would increase the supply of organs for transplant sufficiently to eliminate the very large queues in organ markets, and the suffering and deaths of many of those waiting, without increasing the total cost of transplant surgery by more than about 12 percent. We build on the value-of-life literature and other parts of economic analysis to estimate the equilibrium cost of live transplants for kidneys and livers. We also show that market price for kidneys will be determined by the cost of live donations, even though most organs will come from cadavers.

/pdf/introducing-incentives-in-the-market-for-live-and-cadaveric-3kdlmqc1sw.pdf

Introducing incentives in the market for live and cadaveric organ donations.

Task force 3: Recipient guidelines/prioritization

Early results with partial left ventriculectomy

Objectives. —To estimate the potential supply of organ donors and to measure the efficiency of organ procurement efforts in the United States. Methods. —A geographic database has been developed consisting of multiple cause of death and sociodemographic data compiled by the National Center for Health Statistics. All deaths are evaluated as to their potential for organ donation. Two classes of potential donors are identified: class 1 estimates are restricted to causes of death involving significant head trauma only, and class 2 estimates include class 1 estimates as well as deaths in which brain death was less probable. Results. —Over 23000 people are currently awaiting a kidney, heart, liver, heart-lung, pancreas, or lung transplantation. Donor supply is inadequate, and the number of donors remained unchanged at approximately 4000 annually for 1986 through 1989, with a modest 9.1% increase in 1990. Between 6900 and 10700 potential donors are available annually (eg, 28.5 to 43.7 per million population). Depending on the class of donor considered, organ procurement efforts are between 37% and 59% efficient. Efficiency greatly varies by state and organ procurement organization. Conclusions. —Many more organ donors are available than are being accessed through existing organ procurement efforts. Realistically, it may be possible to increase by 80% the number of donors available in the United States (up to 7300 annually). It is conceivable, although unlikely, that the supply of donor organs could achieve a level to meet demand. ( JAMA . 1992;267:239-246)

Carlyn E. Orians

Papers

The potential supply of organ donors. An assessment of the efficacy of organ procurement efforts in the United States.