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Levan ML, Massie AB, Trahan C, Hewlett J, Strout T, Klitenic SB, Vanterpool KB, Segev DL, Adams BL, Niles P. Maximizing the use of potential donors through increased rates of family approach for authorization. Am J Transplant 2022; 22:2834-2841. [PMID: 36062407 DOI: 10.1111/ajt.17194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 01/25/2023]
Abstract
In the United States, a small proportion of potential deceased organ donor referrals lead to donation and recovery. Understanding variation in the processes involved between organ procurement organizations (OPOs) may help increase deceased donation and reduce the organ shortage. We studied 103 923 referrals from 10 OPOs from 2018 to 2019, of which 14.4% led to approach for authorization, 8.2% led to authorization, 5.1% led to organ recovery, and 4.8% led to transplantation. First-person authorization (FPA) was associated with threefold higher odds of donation (OR = 2.83 3.02 3.22 , p < .001). Female referrals had 11% lower odds of approach; when approached, Black and Hispanic referrals had 46% and 35% lower odds of authorization, respectively (all p < .001). There was substantial OPO-level variation in rates of approach, authorization, and organ recovery, which persisted after adjusting for age, sex, race, and FPA status. An OPO's relative rate of approach correlated strongly with its relative rate of donation among all referrals (ρ = 0.43). Correlation between an individual OPO's authorization rate among approached families, and overall rate of donation, was negative, suggesting that high authorization rates may be the result of selective approach practices. Therefore, approaching a higher proportion of families for authorization may lead to higher donation rates.
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Affiliation(s)
- Macey L Levan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Chad Trahan
- Southwest Transplant Alliance, Dallas, Texas, USA
| | | | - Tyler Strout
- Southwest Transplant Alliance, Dallas, Texas, USA
| | - Samantha B Klitenic
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen B Vanterpool
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
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2
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Zhang Z, Jin J, Luo C, Chen A. Excavating the social representations and perceived barriers of organ donation in China over the past decade: A hybrid text analysis approach. Front Public Health 2022; 10:998737. [PMID: 36225769 PMCID: PMC9549352 DOI: 10.3389/fpubh.2022.998737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/06/2022] [Indexed: 01/26/2023] Open
Abstract
Background Organ donation has been claimed as a prosocial behavior to prolong the recipient's life and deliver great love. However, the supply-demand ratio of organs in China is highly unbalanced. Being entangled with multiple factors derived from individual and supra-individual levels, organ donation in China is important but sensitive. Previous scholars usually depended on obtrusive approaches to explore the facilitators and hindrances of organ donation, which is hard to discover genuine perceptions toward organ donation. Besides, relatively limited scholarly attention has been paid to what hampers organ donation in China. Objective We intended to excavate the diversified social representations and perceived barriers to organ donation in China over the past decade. Method Two kinds of text analysis methods-semantic network analysis and conventional content analysis, were applied to 120,172 posts from ordinary users on the Sina Weibo platform to address the research questions. Results Regarding social representations, the "hope, understanding, and acceptance" of organ donation was the most pronounced one (34% of the whole semantic network), followed by "family story" (26%), "the procedure of organ donation in NGOs" (15%), "the practical value of organ donation" (14%), and "organ donation in the medical context" (11%). Regarding perceived barriers, a four-layer framework was constructed, including (1) the individual level, mainly about the fear of death and postmortem autopsy; (2) the familial level, which refers to the opposition from family members; (3) the societal level, which alludes to distrust toward medical institutions and the general society; (4) the cultural level, which covers religious-cultural concerns about fatalism. Conclusion In concordance with prior works on social representations regarding organ donation, the current study also uncovered the coexistence of antithetical representations about organ donation-the longing for survival and the fear of death. This representation pair serves as the foundation of Chinese people's ambivalence. Besides, family-related narratives were dispersed over various representations, demonstrating the critical position of family support in organ donation. Moreover, the four-layer framework concerning donation barriers affords a reference for future empirical studies. The practical implications of this work are further discussed.
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Affiliation(s)
- Zizhong Zhang
- School of Journalism and Communication, Tsinghua University, Beijing, China
| | - Jing Jin
- School of Journalism and Communication, Tsinghua University, Beijing, China
| | - Chen Luo
- School of Journalism and Communication, Wuhan University, Wuhan, China,*Correspondence: Chen Luo
| | - Anfan Chen
- School of Journalism and Communication, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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3
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Ross-Driscoll K, Gunasti J, Lynch RJ, Massie A, Segev DL, Snyder J, Axelrod D, Patzer RE. Listing at non-local transplant centers is associated with increased access to deceased donor kidney transplantation. Am J Transplant 2022; 22:1813-1822. [PMID: 35338697 PMCID: PMC9580509 DOI: 10.1111/ajt.17044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 01/25/2023]
Abstract
The ability of kidney transplant candidates to travel outside of their usual place of care varies by sociodemographic factors, potentially exacerbating disparities in access. We used Transplant Referral Regions (TRRs) to overcome previous methodological barriers of using geographic distance to assess the characteristics and outcomes of patients listed for kidney transplant at centers in neighboring TRR or beyond neighboring TRRs. Among listed kidney transplant candidates, 20.9% traveled to a neighbor and 5.6% beyond a neighbor. A higher proportion of travelers were White, had some college education, and lived in ZIP codes with lower poverty. Travel to a neighbor was associated with a 7% increase in likelihood of deceased donor transplant (cHR: 1.07, 95% CI: 1.05, 1.09) and traveling beyond a neighbor with a 19% increase (cHR: 1.19, 95% CI: 1.15, 1.24). Travelers had similar rates of living donor transplant and waitlist mortality as patients who did not travel; those who traveled beyond a neighbor had slightly lower posttransplant mortality (HR: 0.91, 95% CI: 0.83, 0.99). In conclusion, the ability to travel outside of the recipient's assigned TRR increases access to transplantation and improves long-term survival.
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Affiliation(s)
- Katherine Ross-Driscoll
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathan Gunasti
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia,Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Raymond J. Lynch
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Allan Massie
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Jon Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota,Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - David Axelrod
- Solid Organ Transplant Center, Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Rachel E. Patzer
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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4
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Doby BL, Hanner K, Johnson S, Purnell TS, Shah MB, Lynch RJ. Results of a data-driven performance improvement initiative in organ donation. Am J Transplant 2021; 21:2555-2562. [PMID: 33314706 DOI: 10.1111/ajt.16442] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 01/25/2023]
Abstract
New metrics for organ procurement organization (OPO) performance utilize National Center for Health Statistics data to measure cause, age, and location consistent (CALC) deaths. We used this denominator to identify opportunities for improved donor conversion at one OPO, Indiana Donor Network (INOP). We sought to determine whether such analyses are immediately actionable for quality improvement (QI) initiatives directed at increased donor conversion. CALC-based assessment of INOP's performance revealed an opportunity to improve conversion of older donors. Following the QI initiative, INOP donor yield rose by 44%, while organs transplanted rose by 29%. These changes tolerated temporary disruption around the COVID-19 pandemic. Improved donor yield was primarily seen in older groups identified by CALC-based methods. Process changes in resource allocation and monitoring were associated with a 57% increase in the number of potential donors approached in the QI period and a subsequent rise in the number of potential donor referrals, suggesting positive feedback at area hospitals. Post-intervention, INOP's projected donation performance rose from 51st to 18th among all OPOs. OPOs can use CALC death data to accurately assess donor conversion by categories including age and race/ethnicity. These data can be used in real time to inform OPO-level processes to maximize donor recovery.
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Affiliation(s)
- Brianna L Doby
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Tanjala S Purnell
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Malay B Shah
- Department of Surgery, Division of Abdominal Transplant Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Raymond J Lynch
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia
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5
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Niroomand E, Mantero A, Narasimman M, Delgado C, Goldberg D. Rapid improvement in organ procurement organization performance: Potential for change and impact of new leadership. Am J Transplant 2020; 20:3567-3573. [PMID: 32476235 DOI: 10.1111/ajt.16085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/29/2020] [Accepted: 05/15/2020] [Indexed: 01/25/2023]
Abstract
Recently proposed rulemaking from Centers for Medicare and Medicaid Services would change how organ procurement organizations (OPOs) are evaluated. The proposals include using national inpatient death data to define a standardized denominator to calculate comparable donation rates among OPOs. Based on these objective metrics, OPOs not performing at a prespecified threshold will be required to rapidly improve performance to avoid decertification. We sought to determine whether rapid OPO improvement was possible based on objective donation metrics, and whether leadership change was associated with rapid improvement. We evaluated United Network for Organ Sharing and Centers for Disease Control and Prevention (CDC) data from 2011 to 2018, and measured donation rates using CDC data on inpatient deaths from causes consistent with donation, based on the location of deaths. During the two 4-year cycles, we found that an OPO's ranking relative to other OPOs was fairly static, with more than 90% of the OPOs at risk of flagging at the end of each 4-year cycle (2014, 2018) being in the bottom 75% of OPOs in the preceding 3 years. In multivariable logistic regression models, leadership changes were only statistically significantly associated with an improvement in OPO rankings during the 2011-2014 cycle. These data demonstrate that rapid improvements in OPO performance are uncommon, and while leadership changes increase the odds of rapid improvement, they do not guarantee improvement.
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Affiliation(s)
- Elaheh Niroomand
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Alejandro Mantero
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Cindy Delgado
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - David Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
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6
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Mone T, Danovitch G. US Organ Procurement Organization Donation Principles, Laws, and Practices. Am J Kidney Dis 2020; 76:735-738. [PMID: 32981792 PMCID: PMC7516933 DOI: 10.1053/j.ajkd.2020.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 05/26/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | - Gabriel Danovitch
- Kidney and Pancreas Transplant Program, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
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7
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Goldberg D, Karp S, Shah MB, Dubay D, Lynch R. Importance of incorporating standardized, verifiable, objective metrics of organ procurement organization performance into discussions about organ allocation. Am J Transplant 2019; 19:2973-2978. [PMID: 31199562 DOI: 10.1111/ajt.15492] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/08/2019] [Accepted: 06/08/2019] [Indexed: 02/06/2023]
Abstract
Identifying and supporting specific organ procurement organizations (OPOs) with the greatest opportunity to increase donation rates could significantly increase the number of organs available for transplant. Accomplishing this is complicated by current Scientific Registry of Transplant Recipients/Centers for Medicare & Medicaid Services metrics of donation rates and OPO performance that rely on eligible deaths. These data are self-reported and unverifiable and have been shown to underestimate potential organ donors. We examine the limitations of current OPO performance/donation metrics to inform discussions related to strategies to increase donation. We propose changing to a simple, verifiable, and uniformly applied donation metric. This would allow the transplant community to (1) better understand inherent differences in donor availability based on geography and (2) identify underperforming areas that would benefit from systems improvement agreements to increase donation rates.
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Affiliation(s)
- David Goldberg
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Seth Karp
- Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Malay B Shah
- Division of Transplantation, Department of Surgery, University of Kentucky Medical Center, Lexington, Kentucky
| | - Derek Dubay
- Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Raymond Lynch
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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8
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Cannon RM, Jones CM, Davis EG, Franklin GA, Gupta M, Shah MB. Patterns of geographic variability in mortality and eligible deaths between organ procurement organizations. Am J Transplant 2019; 19:2756-2763. [PMID: 30980456 DOI: 10.1111/ajt.15390] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/15/2019] [Accepted: 03/26/2019] [Indexed: 01/25/2023]
Abstract
Eligible deaths are currently used as the denominator of the donor conversion ratio to mitigate the effect of varying mortality patterns in the populations served by different organ procurement organizations (OPOs). Eligible death is an OPO-reported metric rather than a product of formal epidemiological analysis, however, and may be confounded with OPO performance. Using Scientific Registry of Transplant Recipients and Centers for Disease Control and Prevention data, patterns of mortality and eligible deaths within each OPO were analyzed with the use of formal geostatistical analysis to determine whether eligible deaths truly reflect the geographic patterns they are intended to mitigate. There was a 2.1-fold difference in mortality between the OPOs with the highest and lowest rates, with significant positive spatial autocorrelation evident in mortality rates (Moran I = .110; P < .001), meaning geographically proximate OPOs tended to have similar mortality rates. The eligible death ratio demonstrated greater variability, with a 4.5-fold difference between the OPOs with the highest and lowest rates. Contrary to the pattern of mortality rates, the geographic distribution of eligible deaths among OPOs was random (Moran I = -.002; P = .410). This finding suggests geographic patterns do not play a significant role in eligible deaths, thus questioning its continuing use in OPO performance comparisons.
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Affiliation(s)
- Robert M Cannon
- Hiram C. Polk Jr. MD Department of Surgery, Division of Transplantation, University of Louisville, Louisville, Kentucky
| | - Christopher M Jones
- Hiram C. Polk Jr. MD Department of Surgery, Division of Transplantation, University of Louisville, Louisville, Kentucky
| | - Eric G Davis
- Hiram C. Polk Jr. MD Department of Surgery, Division of Transplantation, University of Louisville, Louisville, Kentucky
| | - Glen A Franklin
- Hiram C. Polk Jr. MD Department of Surgery, Division of Transplantation, University of Louisville, Louisville, Kentucky.,Kentucky Organ Donor Affiliates, Louisville, Kentucky
| | - Meera Gupta
- Department of Surgery, Division of Transplantation, University of Kentucky, Lexington, Kentucky
| | - Malay B Shah
- Department of Surgery, Division of Transplantation, University of Kentucky, Lexington, Kentucky
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9
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Regional Variation in Utilization and Outcomes of Liver Allografts From Donors With High Body Mass Index and Graft Macrosteatosis: A Role for Liver Biopsy. Transplantation 2019; 103:122-130. [PMID: 30048394 DOI: 10.1097/tp.0000000000002379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Obesity, defined as a high body mass index (hBMI) of 30 kg/m or greater, is a growing epidemic worldwide and is associated with multiple comorbidities. High BMI individuals account for an increasing portion of potential liver donors. Here we evaluate trends in the utilization and outcomes of hBMI donors on a national and regional level and the potential role of liver biopsy in donor evaluation. METHODS United Network for Organ Sharing Standard Transplant Analysis and Research database was evaluated for deceased donor liver transplants between 2006 and 2016 across 11 Organ Procurement and Transplantation Network regions. High BMI donors were compared with lower BMI counterparts and evaluated for biopsy rates, utilization rates and allograft outcomes. Univariate and multivariable analyses were performed. RESULTS Seventy-seven thousand fifty potential donors were identified and 60 200 transplants were evaluated. Utilization rates for hBMI donors were 66.1% versus 78.1% for lower BMI donors (P < 0.001). Pretransplant biopsy was performed more frequently in hBMI donors (52.1% vs 33.1%, P < 0.001) and macrosteatosis of 30% or greater was identified more often (21.1% vs 12.2%, P < 0.001). Biopsy performance increased utilization rate of hBMI donors in 7 of 11 Organ Procurement and Transplantation Network regions. region 6 showed the highest rate of biopsy performance, high rate of hBMI donor utilization, and highest 5-year estimated graft survival rates of all regions. CONCLUSIONS High BMI donors have not previously been associated with worse graft survival in multivariable analyses; however, they are used much less frequently. Liver biopsy may increase the utilization rate of hBMI donors and improve donor selection. Further evaluation of regions with high rates of utilization and good outcomes is warranted.
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10
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Evolution of Deceased Organ Donation Activity Versus Efficiency Over a 15-year Period: An International Comparison. Transplantation 2019; 102:1768-1778. [PMID: 29677069 DOI: 10.1097/tp.0000000000002226] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
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11
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Hornby K, Shemie SD, Appleby A, Dodd N, Gill J, Kim J, Kramer A, Kutsogiannis DJ, Lahaie N, MacLean J, Rehel L, Webster G, Wu J, Scales DC. Development of a national minimum data set to monitor deceased organ donation performance in Canada. Can J Anaesth 2019; 66:422-431. [PMID: 30689134 PMCID: PMC9630239 DOI: 10.1007/s12630-018-01290-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/22/2018] [Accepted: 10/29/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose Deceased donation data requires standardization to enable accurate interprovincial and international comparisons of deceased donation performance. In Canada, most provincial organ donation organizations (ODOs) have developed different processes and infrastructures for referring potential donors and subsequent data collection. This has led to differing definitions of the performance measures used for each step in the donation process, from potential donor identification to consent to transplantation. The Deceased Donation Data Working Group (DDDWG), comprised of representatives from ODOs across Canada, was therefore convened by Canadian Blood Services to develop a national, comprehensive, standardized deceased donation minimum data set. Methods The DDDWG’s scope encompassed considering all potential deceased organ donation data elements, including operational and performance data collected along the deceased donor pathway from donation potential to donation and disposition of organs. An environmental scan was conducted of other existing deceased donation registries from the Canadian and the international community. The DDDWG then engaged in regular face-to-face meetings and teleconferences to develop recommendations for the minimum data set that would satisfy key considerations, including the impact on existing ODO data collection processes, financial impact on stakeholders, the clinical and operational needs of multiple healthcare professionals involved in the deceased donation pathway, and availability of other existing national data sets that could be leveraged to reduce data collection burden. Results The key deceased donation data elements identified by the DDDWG are contained in an inverted pyramid framework that was derived from similar work conducted in other countries. Conclusion The DDDWG developed recommendations for proposed definitions and data sources that should be adopted nationally to guide the collection of deceased donation data. The ultimate purpose of the final minimum data set is to harmonize and standardize donation data definitions in Canada and align with international standards; inform the development of operational and clinical practice standards at the provincial and national levels; develop a framework for deceased donation performance measures; and advance the science of deceased donation.
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Affiliation(s)
- Karen Hornby
- Research Support Services Program, Trillium Gift of Life Network, Toronto, ON, Canada
| | - Sam D Shemie
- Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre, and Department of Pediatrics, McGill University, Montréal, QC, Canada.,Deceased Donation, Canadian Blood Services, Ottawa, ON, Canada
| | - Amber Appleby
- Deceased Donation and Transplantation, Medical Services and Innovation, Canadian Blood Services, Vancouver, BC, Canada
| | - Nancy Dodd
- Transplant Manitoba - Gift of Life, Winnipeg, MB, Canada
| | - Jaghir Gill
- Department of Medicine (Nephrology), St. Paul's Hospital, BC Transplant, Vancouver, BC, Canada
| | - Joseph Kim
- Department of Medicine (Nephrology), Kidney Transplant Program Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andreas Kramer
- Departments of Critical Care Medicine and Clinical Neurosciences, Southern Alberta Organ and Tissue Donation Program, Neurocritical Care, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - D Jim Kutsogiannis
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Human Organ Donation and Procurement, Edmonton, AB, Canada
| | - Nick Lahaie
- Information Management, Canadian Blood Services, Ottawa, ON, Canada
| | - Janet MacLean
- Clinical Affairs, Trillium Gift of Life Network, Toronto, ON, Canada
| | - Louise Rehel
- Clinical Services, Transplant Québec, Montréal, QC, Canada
| | - Greg Webster
- Acute and Ambulatory Care Information Services, Canadian Institute for Health Information, Toronto, ON, Canada
| | - Juliana Wu
- Decision Support, CORR and Trauma Registries, Canadian Institute for Health Information, Toronto, ON, Canada
| | - Damon C Scales
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
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12
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Goldberg D, Kallan MJ, Fu L, Ciccarone M, Ramirez J, Rosenberg P, Arnold J, Segal G, Moritsugu KP, Nathan H, Hasz R, Abt PL. Changing Metrics of Organ Procurement Organization Performance in Order to Increase Organ Donation Rates in the United States. Am J Transplant 2017; 17:3183-3192. [PMID: 28726327 DOI: 10.1111/ajt.14391] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/05/2017] [Accepted: 06/05/2017] [Indexed: 01/25/2023]
Abstract
The shortage of deceased-donor organs is compounded by donation metrics that fail to account for the total pool of possible donors, leading to ambiguous donor statistics. We sought to assess potential metrics of organ procurement organizations (OPOs) utilizing data from the Nationwide Inpatient Sample (NIS) from 2009-2012 and State Inpatient Databases (SIDs) from 2008-2014. A possible donor was defined as a ventilated inpatient death ≤75 years of age, without multi-organ system failure, sepsis, or cancer, whose cause of death was consistent with organ donation. These estimates were compared to patient-level data from chart review from two large OPOs. Among 2,907,658 inpatient deaths from 2009-2012, 96,028 (3.3%) were a "possible deceased-organ donor." The two proposed metrics of OPO performance were: (1) donation percentage (percentage of possible deceased-donors who become actual donors; range: 20.0-57.0%); and (2) organs transplanted per possible donor (range: 0.52-1.74). These metrics allow for comparisons of OPO performance and geographic-level donation rates, and identify areas in greatest need of interventions to improve donation rates. We demonstrate that administrative data can be used to identify possible deceased donors in the US and could be a data source for CMS to implement new OPO performance metrics in a standardized fashion.
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Affiliation(s)
- D Goldberg
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA.,Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Philadelphia, PA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - M J Kallan
- Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - L Fu
- The Bridgespan Group, New York, NY
| | | | | | | | | | | | - K P Moritsugu
- Former Acting Surgeon General of the United States, Great Falls, MT
| | - H Nathan
- Gift of Life Institute, Philadelphia, PA
| | - R Hasz
- Gift of Life Institute, Philadelphia, PA
| | - P L Abt
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA
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13
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Traino HM, Molisani AJ, Siminoff LA. Regional Differences in Communication Process and Outcomes of Requests for Solid Organ Donation. Am J Transplant 2017; 17:1620-1627. [PMID: 27982508 PMCID: PMC5444960 DOI: 10.1111/ajt.14165] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 11/18/2016] [Accepted: 12/04/2016] [Indexed: 01/25/2023]
Abstract
Although federal mandate prohibits the allocation of solid organs for transplantation based on "accidents of geography," geographic variation of transplantable organs is well documented. This study explores regional differences in communication in requests for organ donation. Administrative data from nine partnering organ procurement organizations and interview data from 1339 family decision makers (FDMs) were compared across eight geographically distinct US donor service areas (DSAs). Authorization for organ donation ranged from 60.4% to 98.1% across DSAs. FDMs from the three regions with the lowest authorization rates reported the lowest levels of satisfaction with the time spent discussing donation and with the request process, discussion of the least donation-related topics, the highest levels of pressure to donate, and the least comfort with the donation decision. Organ procurement organization region predicted authorization (odds ratios ranged from 8.14 to 0.24), as did time spent discussing donation (OR = 2.11), the number of donation-related topics discussed (OR = 1.14), and requesters' communication skill (OR = 1.14). Standardized training for organ donation request staff is needed to ensure the highest quality communication during requests, optimize rates of family authorization to donation in all regions, and increase the supply of organs available for transplantation.
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Affiliation(s)
- HM Traino
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - AJ Molisani
- Department of Health Behavior & Policy, Virginia Commonwealth University, Richmond, VA
| | - LA Siminoff
- College of Public Health, Temple University, Philadelphia, PA
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14
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Abstract
OBJECTIVE To describe the current practice of pediatric organ donor management in the United States for donors declared dead based upon neurologic criteria. The study directs particular attention to how pediatric donors are defined, the use of donor management guidelines, the use of donor management goals, and the involvement of pediatric critical care or transplantation expertise. DESIGN Cross-sectional observational study using a web-based survey and follow-up telephone interview with respondents from U.S. organ procurement organizations. The study also incorporated organ procurement organization-specific data on organ yield for the 4-year period (2010-2013) preceding the study. SETTING The 58 U.S. organ procurement organizations. SUBJECTS Respondents chosen by each organ procurement organization. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All 58 U.S. organ procurement organizations participated in the study. Fifty-two respondents (90%) indicated that their organ procurement organization distinguished pediatric from adult donors resulting in 28 unique pediatric definitions. Thirty-nine organ procurement organizations utilized some form of written pediatric management guidelines, and 27 (47%) maintained pediatric donor management goals; compliance was infrequently monitored for both guidelines (28%) and goals (33%). A pediatric intensivist was always or usually involved in pediatric donor management at 47 organ procurement organizations (81%); transplant/organ recovery surgeons were always or usually involved at 12 organ procurement organizations (21%). There was an increase in the number of organs transplanted per donor among donors 11-17 years old for organ procurement organizations that used donor management goals for the duration of the period studied (p < 0.01). There was also an increase in the ratio of observed/expected organs transplanted among donors of 0-10 years old for organ procurement organizations that always or usually consulted a transplant/organ recovery surgeon (p = 0.02) although this did not reach our threshold for statistical significance.. CONCLUSIONS There is little consensus among organ procurement organizations regarding the definition of "pediatric" during organ donor management. Most organ procurement organizations employ written pediatric guidelines and use pediatric intensive care physicians for assistance in managing these donors. There is a positive association between the use of donor management goals and organ yield among pediatric donors in the 11- to 17-year age group.
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Girlanda R. Deceased organ donation for transplantation: Challenges and opportunities. World J Transplant 2016; 6:451-459. [PMID: 27683626 PMCID: PMC5036117 DOI: 10.5500/wjt.v6.i3.451] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/25/2016] [Accepted: 07/18/2016] [Indexed: 02/05/2023] Open
Abstract
Organ transplantation saves thousands of lives every year but the shortage of donors is a major limiting factor to increase transplantation rates. To allow more patients to be transplanted before they die on the wait-list an increase in the number of donors is necessary. Patients with devastating irreversible brain injury, if medically suitable, are potential deceased donors and strategies are needed to successfully convert them into actual donors. Multiple steps in the process of deceased organ donation can be targeted to increase the number of organs suitable for transplant. In this review, after describing this process, we discuss current challenges and potential strategies to expand the pool of deceased donors.
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Klassen DK, Edwards LB, Stewart DE, Glazier AK, Orlowski JP, Berg CL. The OPTN Deceased Donor Potential Study: Implications for Policy and Practice. Am J Transplant 2016; 16:1707-14. [PMID: 26813036 DOI: 10.1111/ajt.13731] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/06/2016] [Accepted: 01/17/2016] [Indexed: 01/25/2023]
Abstract
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.
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Affiliation(s)
- D K Klassen
- United Network for Organ Sharing, Richmond, VA
| | - L B Edwards
- Research Department, United Network for Organ Sharing, Richmond, VA
| | - D E Stewart
- Research Department, United Network for Organ Sharing, Richmond, VA
| | | | - J P Orlowski
- LifeShare Transplant Donor Services of Oklahoma, Oklahoma City, OK
| | - C L Berg
- Department of Medicine, Duke University School of Medicine, Durham, NC
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17
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Hirose R, Gentry SE, Mulligan DC. Increasing the Number of Organs Available to Transplant Is Separate From Ensuring Equitable Distribution of Available Organs: Both Are Important Goals. Am J Transplant 2016; 16:728-9. [PMID: 26757240 DOI: 10.1111/ajt.13577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 09/17/2015] [Accepted: 10/04/2015] [Indexed: 01/25/2023]
Affiliation(s)
- R Hirose
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - S E Gentry
- Department of Mathematics, United States Naval Academy, Annapolis, MD
| | - D C Mulligan
- Department of Surgery, Yale University School of Medicine, New Haven, CT
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18
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Ladin K, Wang R, Fleishman A, Boger M, Rodrigue JR. Does Social Capital Explain Community-Level Differences in Organ Donor Designation? Milbank Q 2015; 93:609-41. [PMID: 26350932 DOI: 10.1111/1468-0009.12139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 11/29/2022] Open
Abstract
POLICY POINTS The growing shortage of life-saving organs has reached unprecedented levels, with more than 120,000 Americans waiting for them. Despite national attempts to increase organ donation and federal laws mandating the equitable allocation of organs, geographic disparities remain. A better understanding of the contextual determinants of organ donor designation, including social capital, may enhance efforts to increase organ donation by raising the probability of collective action and fostering norms of reciprocity and cooperation while increasing costs to defectors. Because community-level factors, including social capital, predict more than half the variation in donor designation, future interventions should tailor strategies to specific communities as the unit of intervention. CONTEXT The growing shortage of organs has reached unprecedented levels. Despite national attempts to increase donation and federal laws mandating the equitable allocation of organs, their availability and waiting times vary significantly nationwide. Organ donor designation is a collective action problem in public health, in which the regional organ supply and average waiting times are determined by the willingness of individuals to be listed as organ donors. Social capital increases the probability of collective action by fostering norms of reciprocity and cooperation while increasing costs to defectors. We examine whether social capital and other community-level factors explain geographic variation in organ donor designation rates in Massachusetts. METHODS We obtained a sample of 3,281,532 registered drivers in 2010 from the Massachusetts Department of Transportation Registry of Motor Vehicles (MassDOT RMV). We then geocoded the registry data, matched them to 4,466 census blocks, and linked them to the 2010 US Census, the American Community Survey (ACS), and other sources to obtain community-level sociodemographic, social capital (residential segregation, voter registration and participation, residential mobility, violent-death rate), and religious characteristics. We used spatial modeling, including lagged variables to account for the effect of adjacent block groups, and multivariate regression analysis to examine the relationship of social capital and community-level characteristics with organ donor designation rates. FINDINGS Block groups with higher levels of social capital, racial homogeneity, income, workforce participation, owner-occupied housing, native-born residents, and white residents had higher rates of organ donor designation (p < 0.001). These factors remained significant in the multivariate model, which explained more than half the geographic variance in organ donor designation (R(2) = 0.52). CONCLUSIONS The findings suggest that community-level factors, including social capital, predict more than half the variation in donor designation. Future interventions should target the community as the unit of intervention and should tailor messaging for areas with low social capital.
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Affiliation(s)
- Keren Ladin
- Tufts University.,Tufts University Medical School
| | | | | | | | - James R Rodrigue
- Harvard Medical School.,Transplant Institute, Beth Israel Deaconess Medical Center
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Gentry S, Chow E, Massie A, Segev D. Gerrymandering for Justice: Redistricting U.S. Liver Allocation. INTERFACES 2015; 45:462-480. [PMID: 34421152 PMCID: PMC8376030 DOI: 10.1287/inte.2015.0810] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
U.S. organ allocation policy sequesters livers from deceased donors within arbitrary geographic boundaries, frustrating the intent of those who wish to offer the livers to transplant candidates based on medical urgency. We used a zero-one integer program to partition 58 donor service areas into between four and eight sharing districts that minimize the disparity in liver availability among districts. Because the integer program necessarily suppressed clinically significant differences among patients and organs, we tested the optimized district maps with a discrete-event simulation tool that represents liver allocation at a per-person, per-organ level of detail. In April 2014, the liver committee of the Organ Procurement and Transplantation Network (OPTN) decided in a unanimous vote of 22-0-0 to write a policy proposal based on our eight-district and four-district maps. The OPTN board of directors could implement the policy after the proposal and public-comment period.Redistricting liver allocation would save hundreds of lives over the next five years and would attenuate the serious geographic inequity in liver transplant offers.
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Affiliation(s)
- Sommer Gentry
- Mathematics Department, United States Naval Academy, Annapolis, Maryland 21402; and Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
| | - Eric Chow
- Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
| | - Allan Massie
- Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Johns Hopkins University School of Public Health, Baltimore, Maryland 21287
| | - Dorry Segev
- Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Johns Hopkins University School of Public Health, Baltimore, Maryland 21287
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20
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Goldberg DS, French B, Abt PL, Gilroy RK. Increasing the Number of Organ Transplants in the United States by Optimizing Donor Authorization Rates. Am J Transplant 2015; 15:2117-25. [PMID: 26031323 DOI: 10.1111/ajt.13362] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/23/2015] [Accepted: 02/26/2015] [Indexed: 01/25/2023]
Abstract
While recent policies have focused on allocating organs to patients most in need and lessening geographic disparities, the only mechanism to increase the actual number of transplants is to maximize the potential organ supply. We conducted a retrospective cohort study using OPTN data on all "eligible deaths" from 1/1/08 to 11/1/13 to evaluate variability in donor service area (DSA)-level donor authorization rates, and to quantify the potential gains associated with increasing authorization rates. Despite adjustments for donor demographics (age, race/ethnicity, cause of death) and geographic factors (rural/urban status of donor hospital, statewide participation in deceased-donor registries) among 52 571 eligible deaths, there was significant variability (p < 0.001) in donor authorization rates across the 58 DSAs. Overall DSA-level adjusted authorization rates ranged from 63.5% to 89.5% (median: 72.7%). An additional 773-1623 eligible deaths could have been authorized, yielding 2679-5710 total organs, if the DSAs with authorization rates below the median and 75th percentile, respectively, implemented interventions to perform at the level of the corresponding reference DSA. Opportunities exist within the current organ acquisition framework to markedly improve DSA-level donor authorization rates. Such initiatives would mitigate waitlist mortality while increasing the number of transplants.
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Affiliation(s)
- D S Goldberg
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - B French
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - P L Abt
- Division of Transplantation, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - R K Gilroy
- Center for Transplantation and Department of Medicine, University of Kansas Medical Center, Kansas City, KS
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21
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Gentry SE, Chow EKH, Massie A, Luo X, Shteyn E, Pyke J, Zaun D, Snyder JJ, Israni AK, Kasiske B, Segev DL. Liver sharing and organ procurement organization performance under redistricted allocation. Liver Transpl 2015; 21:1031-9. [PMID: 25990089 PMCID: PMC4516652 DOI: 10.1002/lt.24171] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 04/24/2015] [Accepted: 04/24/2015] [Indexed: 12/31/2022]
Abstract
Concerns have been raised that optimized redistricting of liver allocation areas might have the unintended result of shifting livers from better-performing to poorer-performing organ procurement organizations (OPOs). We used liver simulated allocation modeling to simulate a 5-year period of liver sharing within either 4 or 8 optimized districts. We investigated whether each OPO's net liver import under redistricting would be correlated with 2 OPO performance metrics (observed to expected liver yield and liver donor conversion ratio), along with 2 other potential correlates (eligible deaths and incident listings above a Model for End-Stage Liver Disease score of 15). We found no evidence that livers would flow from better-performing OPOs to poorer-performing OPOs in either redistricting scenario. Instead, under these optimized redistricting plans, our simulations suggest that livers would flow from OPOs with more-than-expected eligible deaths toward those with fewer-than-expected eligible deaths and that livers would flow from OPOs with fewer-than-expected incident listings to those with more-than-expected incident listings; the latter is a pattern that is already established in the current allocation system. Redistricting liver distribution to reduce geographic inequity is expected to align liver allocation across the country with the distribution of supply and demand rather than transferring livers from better-performing OPOs to poorer-performing OPOs.
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Affiliation(s)
- Sommer E. Gentry
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Mathematics, United States Naval Academy, Annapolis, MD
| | - Eric KH. Chow
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eugene Shteyn
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Joshua Pyke
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - David Zaun
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Jon J. Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Ajay K. Israni
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - Bert Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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Joseph B, Khalil M, Pandit V, Orouji Jokar T, Cheaito A, Kulvatunyou N, Tang A, O'Keeffe T, Vercruysse G, Green DJ, Friese RS, Rhee P. Increasing organ donation after cardiac death in trauma patients. Am J Surg 2015; 210:468-72. [PMID: 26060001 DOI: 10.1016/j.amjsurg.2015.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/06/2015] [Accepted: 03/10/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Organ donation after cardiac death (DCD) is not optimal but still remains a valuable source of organ donation in trauma donors. The aim of this study was to assess national trends in DCD from trauma patients. METHODS A 12-year (2002 to 2013) retrospective analysis of the United Network for Organ Sharing database was performed. Outcome measures were the following: proportion of DCD donors over the years and number and type of solid organs donated. RESULTS DCD resulted in procurement of 16,248 solid organs from 8,724 donors. The number of organs donated per donor remained unchanged over the study period (P = .1). DCD increased significantly from 3.1% in 2002 to 14.6% in 2013 (P = .001). There was a significant increase in the proportion of kidney (2002: 3.4% vs 2013: 16.3%, P = .001) and liver (2002: 1.6% vs 2013: 5%, P = .041) donation among DCD donors over the study period. CONCLUSIONS DCD from trauma donors provides a significant source of solid organs. The proportion of DCD donors increased significantly over the last 12 years.
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Affiliation(s)
- Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
| | - Mazhar Khalil
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Viraj Pandit
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Tahereh Orouji Jokar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Ali Cheaito
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Narong Kulvatunyou
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Andrew Tang
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Terence O'Keeffe
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Gary Vercruysse
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Donald J Green
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Randall S Friese
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Peter Rhee
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
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23
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Donor evaluation in heart transplantation: The end of the beginning. J Heart Lung Transplant 2014; 33:1105-13. [DOI: 10.1016/j.healun.2014.05.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/16/2014] [Accepted: 05/28/2014] [Indexed: 12/20/2022] Open
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Lewis RM, Sankar A, Pittman J. Disparities in access to kidney transplantation between donor service areas in Texas. Am J Transplant 2014; 14:2303-9. [PMID: 25219981 DOI: 10.1111/ajt.12864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/21/2014] [Accepted: 04/23/2014] [Indexed: 01/25/2023]
Abstract
We examined the current status of pronounced disparities in waiting times to kidney transplantation (KTx) within the state of Texas first documented more than a decade ago. The state's three, geographically contiguous donor service areas (DSAs) were compared for rates of deceased donor KTx within 3 years of listing as well as population base; waiting list size; number of dialysis patients; annual eligible deaths; number and size of acute care hospitals; organ procurement organization performance; correspondence between DSA of residence versus DSA of listing; and distribution of alternative local units (ALUs). The data show that significant inequities of access to KTx are persistent, localized to one of the state's three DSAs and disproportionately affect Hispanics as well as counties with lower median family incomes. Imbalances in determinants of supply and demand, discordance between DSAs of residence versus listing and ALU dispositions dating to the 1990s were identified as underlying causes. Parity will not be established by upcoming revisions in national allocation policies that call for regionalizing initial offers of kidneys with the worst 15% of donor profile index scores and elimination of ALUs. Potential remedies include adopting more equitable maximums in waiting time differentials between DSAs within single states.
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Affiliation(s)
- R M Lewis
- Department of Renal Transplantation, St. Davids North Austin Medical Center, Austin, TX
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25
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26
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Weiss J, Coslovsky M, Keel I, Immer FF, Jüni P. Organ donation in Switzerland--an analysis of factors associated with consent rate. PLoS One 2014; 9:e106845. [PMID: 25208215 PMCID: PMC4160222 DOI: 10.1371/journal.pone.0106845] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Aim Switzerland has a low post mortem organ donation rate. Here we examine variables that are associated with the consent of the deceased’s next of kin (NOK) for organ donation, which is a prerequisite for donation in Switzerland. Methods and Analysis During one year, we registered information from NOK of all deceased patients in Swiss intensive care units, who were approached for consent to organ donation. We collected data on patient demographics, characteristics of NOK, factors related to the request process and to the clinical setting. We analyzed the association of collected predictors with consent rate using univariable logistic regression models; predictors with p-values <0.2 were selected for a multivariable logistic regression. Results Of 266 NOK approached for consent, consent was given in 137 (51.5%) cases. In multivariable analysis, we found associations of consent rates with Swiss nationality (OR 3.09, 95% CI: 1.46–6.54) and German language area (OR 0.31, 95% CI: 0.14–0.73). Consent rates tended to be higher if a parent was present during the request (OR 1.76, 95% CI: 0.93–3.33) and if the request was done before brain death was formally declared (OR 1.87, 95% CI: 0.90–3.87). Conclusion Establishing an atmosphere of trust between the medical staff putting forward a request and the NOK, allowing sufficient time for the NOK to consider donation, and respecting personal values and cultural differences, could be of importance for increasing donation rates. Additional measures are needed to address the pronounced differences in consent rates between language regions.
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Affiliation(s)
- Julius Weiss
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Michael Coslovsky
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Isabelle Keel
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Franz F. Immer
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
- * E-mail:
| | - Peter Jüni
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Yeh H, Hunsicker L. Deceased donor liver allocation: cutting the Gordian knot. Am J Transplant 2013; 13:1949-50. [PMID: 23890283 DOI: 10.1111/ajt.12302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 04/11/2013] [Accepted: 04/13/2013] [Indexed: 01/25/2023]
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Davies RR, Haldeman S, Pizarro C. Regional variation in survival before and after pediatric heart transplantation--an analysis of the UNOS database. Am J Transplant 2013; 13:1817-29. [PMID: 23714390 DOI: 10.1111/ajt.12259] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 02/21/2013] [Accepted: 03/14/2013] [Indexed: 01/25/2023]
Abstract
Geographic variation occurs in a variety of health outcomes. Regional influences on outcomes before and after listing for pediatric heart transplantation have not been assessed. Review of the UNOS dataset identified 5398 pediatric (≤ 18 years) patients listed for heart transplantation 2000-2011. Patients were stratified based on the region of listing. Regional-level variables were correlated with individual risk-adjusted outcomes. Mean time spent on the waitlist varied from 91.0 ± 163 days (Region 6 [R6]) to 248.1 ± 493 days (R4, p < 0.0001). Regions with more transplant centers (p < 0.0001) and fewer transplants (p = 0.0015) had higher waitlist mortality. Risk-adjusted individual waitlist mortality varied from 6.9% (R1, CI 6.2-7.8) to 19.2% (R5, CI 18.0-20.6). Waitlist mortality was higher for individuals awaiting transplant in regions with more listings per center (OR 1.04, CI 1.01-1.08) and lower in regions with more donors per center (OR 0.95, CI 0.90-0.99 per donor). Posttransplant risk-adjusted survival varied across regions (R4: 5.4%, CI 4.2-7.4; R7: 18.0%, CI 12.4-32.5), but regional variables were not correlated with outcomes. Outcomes among children undergoing heart transplantation vary by region. Factors leading to increased competition for donor allografts are associated with poorer waitlist survival. Equitable allocation of cardiac allografts requires further investigation of these findings.
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Affiliation(s)
- R R Davies
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, DE, USA.
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Israni AK, Zaun DA, Rosendale JD, Snyder JJ, Kasiske BL. OPTN/SRTR 2011 Annual Data Report: deceased organ donation. Am J Transplant 2013; 13 Suppl 1:179-98. [PMID: 23237701 DOI: 10.1111/ajt.12025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In 2011, the number of eligible deaths (death of a patient aged 70 years or younger who is legally declared brain dead and does not exhibit any excluding factors) was 9023, a slight decrease from 2010; 72.9 eligible donors per 100 eligible deaths were converted to organ donors. The unadjusted donation rate varied by donation service area (DSA), as did the number of transplant programs. The observed/expected organ yield ratio for all organs varied by DSA from 0.89 to 1.13. The total number of organs recovered divided by the number of donors was 3.54, slightly lower than in 2010; this value varied by DSA from 2.91 to 4.19. The number of organs transplanted per donor was 3.07, varying by DSA from 2.28 to 3.37. The discard rate for all organs combined was 0.13 per recovered organ, a value that varied substantially by DSA and by organ type. Reasons for not procuring or for discarding organs varied by organ type. Numbers of intestines, hearts, and lungs procured for transplant but not used are smaller than numbers of kidneys, pancreata, and livers because intestines, hearts, and lungs are recovered only after a transplant center has accepted the organ for transplant.
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Affiliation(s)
- A K Israni
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
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