Culture change initiatives in the procurement of organs in the United kingdom

Factors influencing organ donation in Fujian's Organ Procurement Organization: A retrospective study

INTRODUCTION

The Organ Procurement Organization (OPO) was established in August 2018. The organization's workload, work efficiency, and quality control of organ donation and procurement have continuously improved, making it one of the most successful OPOs in Fujian Province. This study explores the factors that influence the success and failure of organ donation in Fujian Province, China.

METHODS

Data from 236 potential organ donors registered at an OPO in Fujian Province between January 2020 and May 2022 were retrospectively analyzed.

RESULTS

Among the 236 potential organ donors, 71 cases of organ donation were successful (30.08% conversion rate). Univariate analysis showed that demographic factors, such as differences in sex, age, marital status, and domicile location, were significantly associated with successful organ donation (p < .05). Among hospital-related factors, differences in hospital departments were significant (p < .05). Considering disease-related factors, spontaneous respiration was significant (p < .05). For factors related to organ donation, differences in coordinators were significant (p < .05). Multivariate analysis showed that age, domicile location, spontaneous respiration, and coordinators influenced organ donation success (p < .05). Multifactor analysis revealed that factors, such as age ≤50 years, domicile location in other provinces, no spontaneous respiration, and highly skilled coordinators, could promote successful organ donation.

CONCLUSIONS

Programs should clarify the screening criteria for key potential organ donors, enhance the promotion and popularization of organ donation, and boost the number and professional skills of organ donation coordinators to improve the organ donation conversion rate.

A Study of Concerns of Families of Potential Donation After Circulatory Death Donors and Recommendations for Raising Donation Rates

CONTEXT

The request process for donation after circulatory death (DCD) and family concerns about DCD differ in significant ways from the process for, and family concerns about, donation after brain death (DBD). In addition, donation rates for DCDs are typically lower than for DBDs. Although there has been a great deal of research on how the concerns of DBD families impact donation, limited research exists on family concerns and decision-making in the DCD request process.

OBJECTIVE

To determine the concerns of families approached for DCD and explore how those might be addressed to increase DCD donation rates.

DESIGN, SETTING, AND PARTICIPANTS

Written request response forms were completed by organ procurement and family services coordinators from 4 organ procurement organizations in 4 different states. They were filled out as soon as possible after speaking with families about DCD.

MAIN OUTCOME MEASURES

Responses were marked on a 12-item instrument, and anecdotal observations and detailed comments about family concerns, donor registration status, and decisions made were noted.

RESULTS

Family concerns that block DCDs differ in many ways from those that block DBDs. These concerns arise from stresses peculiar to the DCD situation and must be addressed for these types of donations to increase.

PURPOSE OF THE STUDY

The purposes of the study are to identify family concerns about donating organs that are specific to DCD and that may differ from DBD and to distinguish how those concerns might be addressed in ways that increase the likelihood of donation.

Measures influencing post-mortem organ donation rates in Germany, the Netherlands, Spain and the UK : A systematic review

BACKGROUND

German post-mortem organ donation rates have been declining since 2010. Several transplantation scandals led to a negative portrayal of organ donation in the media. Spain, the UK and the Netherlands achieved a rise in organ donation rates while retaining organ donation legislation.

METHODS

A systematic review of publications focusing on (1) organ donation legislation, (2) data on post-mortem organ donation rates and (3) measures to increase post-mortem organ donation rates in Europe was conducted in November 2017 in PubMed, PsycINFO and Web of Science. Quality parameters of the World Bank and the World Health Organization (WHO) were studied to analyze national health services, frequent causes of death and life expectancy.

RESULTS

Quality parameters of national health services were similar in all countries. The Netherlands and Germany have an opt in system. An increase of 37.4% in post-mortem organ donation rates from 2008 to 2015 in the UK was accomplished through the establishment of a donation task force, adopting parts of the Spanish model, while maintaining an opt in system. Spain has the highest organ donation rate worldwide (39.7 per million persons in 2015). The implementation of transplantation coordinators and the change in legislation in Germany in 2012 has so far shown no effect. Public awareness of organ donation in the Netherlands increased following various information campaigns.

CONCLUSION

Donation after cardiac death (DCD), expanded donor criteria, increasing public awareness and introduction of an organ donor register should be discussed as measures to increase organ donation rates in Germany.

Evolution of Deceased Organ Donation Activity Versus Efficiency Over a 15-year Period: An International Comparison

BACKGROUND

The donation rate (DR) per million population is not ideal for an efficiency comparison of national deceased organ donation programs. The DR does not account for variabilities in the potential for deceased donation which mainly depends on fatalities from causes leading to brain death. In this study, the donation activity was put into relation to the mortality from selected causes. Based on that metric, this study assesses the efficiency of different donation programs.

METHODS

This is a retrospective analysis of 2001 to 2015 deceased organ donation and mortality registry data. Included are 27 Council of Europe countries, as well as the United States. A donor conversion index (DCI) was calculated for assessing donation program efficiency over time and in international comparisons.

RESULTS

According to the DCI and of the countries included in the study, Spain, France, and the United States had the most efficient donation programs in 2015. Even though mortality from the selected causes decreased in most countries during the study period, differences in international comparisons persist. This indicates that the potential for deceased organ donation and its conversion into actual donation is far from being similar internationally.

CONCLUSIONS

Compared with the DR, the DCI takes into account the potential for deceased organ donation, and therefore is a more accurate metric of performance. National donation programs could optimize performance by identifying the areas where most potential is lost, and by implementing measures to tackle these issues.

The Physiology of Brain Death and Organ Donor Management

Brain death is associated with complex physiologic changes that may impact the management of the potential organ donor. Medical management is critical to actualizing the individual or family’s intent to donate and maximizing the benefit of that intent. This interval of care in the PICU begins with brain death and consent to donation and culminates with surgical organ procurement. During this phase, risks for hemodynamic instability and compromise of end organ function are high. The brain dead organ donor is in a distinct and challenging pathophysiologic condition that culminates in multifactorial shock. The potential benefits of aggressive medical management of the organ donor may include increased number of donors providing transplantable organs and increased number of organs transplanted per donor. This may improve graft function, graft survival, and patient survival in those transplanted. In this chapter, pathophysiologic changes occurring after brain death are reviewed. General and organ specific donor management strategies and logistic considerations are discussed. There is a significant opportunity for enhancing donor multi-organ function and improving organ utilization with appropriate PICU management.

Current status and recent advances of liver transplantation from donation after cardiac death

The last decade saw increased organ donation activity from donors after cardiac death (DCD). This contributed to a significant proportion of transplant activity. Despite certain drawbacks, liver transplantation from DCD donors continues to supplement the donor pool on the backdrop of a severe organ shortage. Understanding the pathophysiology has provided the basis for modulation of DCD organs that has been proven to be effective outside liver transplantation but remains experimental in liver transplantation models. Research continues on how best to further increase the utility of DCD grafts. Most of the work has been carried out exploring the use of organ preservation using machine assisted perfusion. Both ex-situ and in-situ organ perfusion systems are tested in the liver transplantation setting with promising results. Additional techniques involved pharmacological manipulation of the donor, graft and the recipient. Ethical barriers and end-of-life care pathways are obstacles to widespread clinical application of some of the recent advances to practice. It is likely that some of the DCD offers are in fact probably “prematurely” offered without ideal donor management or even prior to brain death being established. The absolute benefits of DCD exist only if this form of donation supplements the existing deceased donor pool; hence, it is worthwhile revisiting organ donation process enabling us to identify counter remedial measures.

Liver transplantation: Issues for the next 20 years

The growing numbers of potential transplant recipients on waiting lists is increasingly disproportionate to the supply of cadaveric donor organs. The hope for the next 20 years is that supply will satisfy demand. This requires both a reduction in indications for the procedure and an increase in the transplants performed. A multi-pronged approach is needed to increase cadaveric organ donation, generating enthusiasm for donation among both the general public and hospital staff. Accurate assessment of marginal grafts with stringent criteria known to predict graft function will diminish wastage of organs. Methods of rehabilitating marginal grafts during extracorporeal perfusion will increase organ availability. Supply of non-heart beating donors can be greatly expanded and protocols developed with ethical consent to optimize their initial function despite warm ischemia. Splitting livers that fulfill selection criteria, thus providing for two recipients, should be universally applied with acceptable incentives to those units who do not directly benefit. A proportion of recipients, though not those transplanted for autoimmune disease, will be spared the side-effects of immunosuppression thanks to immune tolerance. Protocols for close monitoring of those patients for rejection during treatment withdrawal must be carefully observed. In addition to gene therapy, it is highly likely that hepatocyte transplantation will replace orthotopic grafting in patients without cirrhosis, especially for inherited metabolic diseases. It is much more difficult to envisage that heterologous stem cell transplantation or xenotransplantation will have clinical impact in the next 20 years, although research in those areas has obvious long-term potential.