Breakdown in the Organ Donation Process and Its Effect on Organ Availability

Abstract

Background. This study examines the effect of breakdown in the organ donation process on the availability of transplantable organs. A process breakdown is defined as a deviation from the organ donation protocol that may jeopardize organ recovery. Methods. A retrospective analysis of donation-eligible decedents was conducted using data from an independent organ procurement organization. Adjusted effect of process breakdown on organs transplanted from an eligible decedent was examined using multivariable zero-inflated Poisson regression. Results. An eligible decedent is four times more likely to become an organ donor when there is no process breakdown (adjusted OR: 4.01; 95% CI: 1.6838, 9.6414; P < 0.01) even after controlling for the decedent's age, gender, race, and whether or not a decedent had joined the state donor registry. However once the eligible decedent becomes a donor, whether or not there was a process breakdown does not affect the number of transplantable organs yielded. Overall, for every process breakdown occurring in the care of an eligible decedent, one less organ is available for transplant. Decedent's age is a strong predictor of likelihood of donation and the number of organs transplanted from a donor. Conclusion. Eliminating breakdowns in the donation process can potentially increase the number of organs available for transplant but some organs will still be lost.

Efetividade do processo de doação de órgãos para transplantes

“…(1,2) For the transplant to happen, healthy organs have to be obtained, usually from deceased donors. (3) Several professionals participate in the donation process, especially those working in Intensive Care Units (ICUs) and emergency departments, who are responsible for identifying potential organ and tissue donors, diagnosing brain-death (BD), notifying the responsible institutions and communicating the diagnosis to family members. (4) In Brazil, current legislation determines that the family is responsible for the decision of organ donation after death.…”

What Did We Really Learn From the Collaborative? Is It In Our Best Interest to Use “Every Organ Every Time” in Kidney Transplantation?

“…A reasonable argument could be made to look at more stringent criteria for listing and only wait list candidates with a reasonable likelihood of completely realizing the functioning potential of every transplanted organ. This argument gets more complicated, as tissue matching plays an important role in the long-term outcome of kidney transplants [22]. All these compounding factors highlight the importance of having an appropriate comprehensive organ-allocation system.…”

“…All these compounding factors highlight the importance of having an appropriate comprehensive organ-allocation system. The early results of changes to the current allocation system show a significant increase in transplantation in patients with high cPRA, many with previously failed transplants (some more than once), an increase in cold ischemia time (CIT), and an increase in delayed graft function (DGF) [18•], which have all been historically associated with poorer long-term outcome [22]. Early results after implementation of the KAS also indicate a decrease in the number of transplants in patients with 0 % cPRA, a group that historically has had favorable long-term outcomes after transplantation.…”

Improving OPO performance through national data availability

“…The national transplant system does not collect verified data on ventilated deaths, potential donor deaths, or authorized donors. As such, we do not even know what true donor potential looks like, because the data we actually collect nationally are fractured, self‐reported, and not aggregated in a way that would encourage remediation of issues on a national scale, particularly in the known areas of organ donor process breakdowns . Though cause of death data from the CDC are imperfect, they could potentially be used in the interim as a more accurate denominator for donor potential.…”