Mortalidad hospitalaria en unidades de críticos y muertes encefálicas según los códigos de la Clasificación Internacional de Enfermedades

Examination of the Brain-Dead Organ Donor Management Process at a Spanish Hospital

The number of donors and organs available has not increased at the same rate as the inclusion of new patients in the waiting lists. The aim of the present study was to analyze the quality of the detection process of potential brain-dead organ donors at the Hospital of León. For this, a cross-sectional prospective study was developed on a retrospective cohort of patients who were admitted or died by catastrophic brain damage with the potential for organs donation. Data were collected for six months using hospital records of admissions and exitus. For the statistical analysis, the free distribution software Epi Info 3.5.4 was employed. A total of 627 patients were studied: 550 were discharged and 77 died as potential donors. Of the potential donors, 65 died in asystole, but 60 of them had an absolute contraindication to donation and 20 died after limitation of life support therapy. Five cases with donor criteria in controlled asystole were detected. The analysis found that the detection process conformed to the regulatory framework stablished by the National Transplant Organization. However, population aging leads to a high rate of absolute contraindications among detected potential donors. The donation capacity of the hospital could therefore be increased with the implementation of a donor protocol in controlled asystole.

The OPTN Deceased Donor Potential Study: Implications for Policy and Practice

The Organ Procurement and Transplantation Network (OPTN) Deceased Donor Potential Study, funded by the Health Resources and Services Administration, characterized the current pool of potential deceased donors and estimated changes through 2020. The goal was to inform policy development and suggest practice changes designed to increase the number of donors and organ transplants. Donor estimates used filtering methodologies applied to datasets from the OPTN, the National Center for Health Statistics, and the Agency for Healthcare Research and Quality and used these estimates with the number of actual donors to estimate the potential donor pool through 2020. Projected growth of the donor pool was 0.5% per year through 2020. Potential donor estimates suggested unrealized donor potential across all demographic groups, with the most significant unrealized potential (70%) in the 50-75-year-old age group and potential Donation after Circulatory Death (DCD) donors. Actual transplants that may be realized from potential donors in these categories are constrained by confounding medical comorbidities not identified in administrative databases and by limiting utilization practices for organs from DCD donors. Policy, regulatory, and practice changes encouraging organ procurement and transplantation of a broader population of potential donors may be required to increase transplant numbers in the United States.

Benchmarking in the process of donation after brain death: a methodology to identify best performer hospitals

A benchmarking approach was developed in Spain to identify and spread critical success factors in the process of donation after brain death. This paper describes the methodology to identify the best performer hospitals in the period 2003-2007 with 106 hospitals throughout the country participating in the project. The process of donation after brain death was structured into three phases: referral of possible donors after brain death (DBD) to critical care units (CCUs) from outside units, management of possible DBDs within the CCUs and obtaining consent for organ donation. Indicators to assess performance in each phase were constructed and the factors influencing these indicators were studied to ensure that comparable groups of hospitals could be established. Availability of neurosurgery and CCU resources had a positive impact on the referral of possible DBDs to CCUs and those hospitals with fewer annual potential DBDs more frequently achieved 100% consent rates. Hospitals were grouped into each subprocess according to influencing factors. Hospitals with the best results were identified for each phase and hospital group. The subsequent study of their practices will lead to the identification of critical factors for success, which implemented in an adapted way should fortunately lead to increasing organ availability.

Effect of population aging on the international organ donation rates and the effectiveness of the donation process

This study analyzed the effect of population aging on organ donation for transplants in 43 countries and on the effectiveness of the donation process by comparing the results between Spain and the United States. The percentage of the population aged 65 or over accounted for 33% of the difference in the donation rates between the countries and for 91% of the variation in the rates after age adjustment. However, the level of aging of the Spanish (16.5%) and American (12.3%) populations failed to account for the percentages of deceased donors 65 or over (28% vs. 10%), due to the different age-specific donation rates, much higher in Spain above 50 years. These differences lead to a higher effectiveness of the process in the United States (3.1 transplanted organs per donor vs. 2.5 in Spain), though at lower rates of transplant per million population (73 vs. 87). We conclude that older populations have a greater donation potential as donation rates are strongly associated with population aging. It should therefore be mandatory to adjust donation rates for age before making comparisons. Additionally, effectiveness decreases with older donors, so age should be considered when establishing standards relating to organ donation and effectiveness of the process.