Short-term Results From a Training Program to Improve Organ Donation in Uncontrolled Donation After Circulatory Death

Identifying organ donors attended by prehospital healthcare professionals - A scoping review

INTRODUCTION

Organ donation is a life-saving intervention that provides hope for patients with end-stage organ failure, improving their longevity and quality of life. However, the demand for organs far exceeds the supply, leading to a significant disparity between patients on transplant waiting lists and the availability of suitable organs. To address this issue, innovative strategies, such as uncontrolled donation after circulatory death (uDCD) programs, have been proposed to expand the donor pool to the prehospital setting.

AIM

This study aimed to systematically map the literature and comprehensively evaluate the involvement of prehospital healthcare professionals in identifying potential organ donors, as well as the barriers and systems impacting this process.

METHODS

A scoping literature review was conducted guided by the PRISMA Extension for Scoping Reviews. Four electronic databases and grey literature were searched for articles examining the participation of prehospital healthcare professionals in the organ or tissue donation process. Relevant data were extracted, organised into narrative and tabular formats, and presented.

RESULTS

A total of 33 articles were included for analysis, predominantly focusing on uDCD programs. The review identified a limited evidence-base regarding the role of prehospital healthcare professionals in organ donation. Four common themes emerged: discrepancies in criteria, decision-making processes, bridging strategies, and ethical considerations.

CONCLUSION

This scoping literature review highlights the significant role of prehospital healthcare professionals in identifying and recruiting organ donors from non-traditional settings. Established uDCD systems show promise in alleviating the burden on transplant waitlists. However, there is a lack of consensus on enrolment criteria, transportation, and ethical considerations for uDCD. Further research is needed to address these gaps, establish evidence-based guidelines, and ensure the efficient and ethical utilisation of potential organ donors from unconventional settings.

A Conceptual Framework for Evaluating National Organ Donation and Transplantation Programs

Conceptual frameworks are valuable resources that can be used to guide the planning, evaluation, and development of healthcare services. However, there are currently no comprehensive frameworks focused on organ donation and transplantation that identify the critical factors underlying a successful national program. To address this knowledge gap, we developed a conceptual framework that takes into account all major domains of influence, including political and societal aspects as well as clinical implementation. The framework was initially constructed based on a targeted review of the relevant medical literature. Feedback provided by a panel of international experts was incorporated into the framework via an iterative process. The final framework features 16 essential domains that are critical for initiating and maintaining a successful program and improving the health of patients with organ failure. Of particular note, these domains are subject to three overarching health system principles: responsiveness, efficiency, and equity. This framework represents a first attempt to develop a whole-system view of the various factors that contribute to the success of a national program. These findings provide a useful tool that can be adapted to any jurisdiction and used to plan, evaluate, and improve organ donation and transplantation programs.

Geographic Information System Analysis: Promoting the Organ Donation Process in Andalusia

OBJECTIVE

The objective is to study the geographic distribution of public awareness and acceptance of organ donation in Andalusian municipalities and determine its relationship with each population and the rate of aging.

METHODS

Data on organ donors from the Information System for Autonomous Regional Transplant Coordination in Andalusia were analyzed from 2006 to 2017. The geographic analysis was performed using free software from the Generalitat Valenciana Geographic Information System (gvGIS, Valencia, Spain). Data from the Spanish National Statistics Institute for the year 2017 were used as a reference for population estimates and calculating the rate of aging.

RESULTS

From 2006 to 2017, a total of 3698 donors were registered in Andalusia, 28 of whom were residing in another autonomous community and 120 who were not censored as residents of their municipality, leaving a final total of 3550 donors. The rate of aging in 2017 was 1.02. Choropleth mapping was used to identify donors in each municipality. Population and aging rate in 2017 for these areas were also analyzed.

CONCLUSION

Georeferenced data on organ donation not only reveals spatial differences in the distribution of public acceptance; it also provides insight into the relationship between this distribution and the sociodemographic characteristics of each community. In this study, areas with the least number of donors seem to coincide with difficult accessibility, higher aging index, and low population rates. These maps can assist transplant coordinators in targeting areas for public education and information campaigns to heighten awareness of the positive results of organ donation and potentiate its acceptance.