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.

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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.

Objective To identify modifiable factors that influence relatives’ decision to allow organ donation.

Design Systematic review.

Data sources Medline, Embase, and CINAHL, without language restriction, searched to April 2008.

Review methods Three authors independently assessed the eligibility of the identified studies. We excluded studies that examined only factors affecting consent that could not be altered, such as donor ethnicity. We extracted quantitative results to an electronic database. For data synthesis, we summarised the results of studies comparing similar themes.

Results We included 20 observational studies and audits. There were no randomised controlled trials. The main factors associated with reduced rates of refusal were the provision of adequate information on the process of organ donation and its benefits; high quality of care of potential organ donors; ensuring relatives had a clear understanding of brain stem death; separating the request for organ donation from notification that the patient had died; making the request in a private setting; and using trained and experienced individuals to make the request.

Conclusions Limited evidence suggests that there are modifiable factors in the process of requests for organ donation, in particular the skills of the individual making the request and the timing of this conversation, that might have a significant impact on rates of consent. Targeting these factors might have a greater and more immediate effect on the number of organs for donation than legislative or other long term strategies.

https://www.bmj.com/content/bmj/338/bmj.b991.full.pdf

Modifiable factors influencing relatives’ decision to offer organ donation: systematic review

Background and Purpose—The purpose of this statement is to delineate basic expectations regarding primary palliative care competencies and skills to be considered, learned, and practiced by provide...

Palliative and End-of-Life Care in Stroke A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

ObjectivesTo estimate the potential for solid organ donation; to identify modifiable reasons for nondonation.DesignRetrospective medical records review.SettingSixty-nine acute care hospitals in four geographic areas of the United States in 1990, and a stratified random sample of 89 hospitals in thre

Organ donor potential and performance: Size and nature of the organ donor shortfall

From a retrospective review of 32,562 deaths that occurred in 1988 in the service area of Kentucky Organ Donor Affiliates, an area with a population of 3.4 million, 173 potential solid organ donors were identified for a rate of 50.8 donors per million population base. There were only 38 actual solid organ donors from this potential pool. The physician failed to recognize the potential for donation in 29 instances and in 92, the family refused consent for donation. In the second phase of the study, we analyzed 155 consecutive medically suitable organ donor referrals for one year. A specific focus on the process and timing of the request for donation was made in this review. In 143 of these instances (92 per cent), a clear temporal separation of the explanation of death or the certainty of family acceptance of death before the request for donation yielded a donor success in 53 of 82 instances. In contrast, only 11 of 61 instances resulted in a consent when the discussion of death and donation were combined into one discussion with the family (p less than 0.05). From this study, there seemed to be adequate numbers of organs available to provide for the current pool of recipients within the state of Kentucky. Educational assistance and an ongoing individual patient review of each death improved the donor rate during the time frame of this study. It is essential to allow a temporal separation between the explanation of death and the request for organ donation to maximize actual organ donation.

Garrison Rn

Papers

Organ donor potential and performance: Size and nature of the organ donor shortfall

There is an answer to the shortage of organ donors.