Epidemiology and Comorbidity Burden of Organ Donor Referrals in Australia: Cohort Study 2010–2015

Abstract

Background.Increasing organ donation rates in Australia have been exceeded by a rise in potential donor referrals not proceeding to donate. Referral evaluation is resource-intensive. We sought to characterize organ donor referrals in New South Wales, Australia, and identify predictors of referrals not proceeding to donation.Methods.We performed a cohort study of NSW Organ and Tissue Donation Service logs 2010–2015, describing the prevalence and impact of comorbidities on referral outcome. Logistic regression was used to identify comorbidities influencing outcome and predict probability of donation.Results.Of 2977 referrals, 669 (22%) donated and 2308 (78%) did not. Despite increasing donation rates, the proportion proceeding to donate declined 2010–2015. Among referrals, the prevalence of all comorbidities except cerebrovascular disease increased and was higher among nondonors. History of cardiac disease, ≥65 years of age, chronic kidney or liver disease, malignancy, and absence of cerebrovascular disease were all significantly (P < 0.01) associated with non donation. Hypertension and diabetes did not significantly impact outcome. Predicted probability of donation varied from <1% to 54% depending on comorbidity burden of the referral.Conclusions.Comorbidity burden among donor referrals is increasing. The presence of particular comorbidities may significantly impact referral outcome. A better understanding of referral characteristics associated with non donation may improve the efficiency of the referral process in the context of encouraging routine referrals.

New blood‐borne virus infections among organ transplant recipients: An Australian data‐linked cohort study examining donor transmissions and other HIV, hepatitis C and hepatitis B notifications, 2000‐2015

“…Accepted national policy is for routine HBV vaccination of non-exposed transplant candidates and post-transplant antiviral prophylaxis for both recipients with prior HBV exposure and non-immune recipients from donors previously exposed to HBV. 19,[26][27][28] If such practice did not occur, it may explain differential transmission and non-transmission of HBV from the same deceased donor with active HBV. [29][30][31] This study also adds support for using potential donors who are HCV antibody positive but NAT negative, with no transmission from at least one donor with past HCV.…”

“…The transmission of HBV is known to decrease with recipient vaccination and antiviral use, 23‐25 as is routine in Australia and can be assumed for this cohort. Accepted national policy is for routine HBV vaccination of non‐exposed transplant candidates and post‐transplant antiviral prophylaxis for both recipients with prior HBV exposure and non‐immune recipients from donors previously exposed to HBV 19,26‐28 . If such practice did not occur, it may explain differential transmission and non‐transmission of HBV from the same deceased donor with active HBV 29‐31 .…”

Safety and Biovigilance in Organ Donation (SAFEBOD): Protocol for a Population-Based Cohort Study

“…At the end of 2017, 1388 patients with end-stage chronic disease remained active on the transplant waiting list (964 kidney, 171 liver, 80 heart, 108 lung, 65 pancreas, 3 intestine) [2]. The number of referrals of potential donors has increased exponentially over time, but the number of referrals who go on to become donors has increased modestly in comparison [3,4]. Thus, the proportion of total donor referrals who proceed to donation has decreased over time (Figure 1 [3]).…”

“…The number of referrals of potential donors has increased exponentially over time, but the number of referrals who go on to become donors has increased modestly in comparison [3,4]. Thus, the proportion of total donor referrals who proceed to donation has decreased over time (Figure 1 [3]). A large proportion of donor referrals do not proceed to donation due to biovigilance concerns (Figure 2).…”

“…Risk stratification recommendations for different infectious diseases and cancers are often complex, may not be derived for use in a transplantation setting, and may not be readily accessible in real-time to clinicians making decisions about donor safety. Inconsistencies in decisions about the medical suitability of referred donors suggest considerable clinical uncertainty [3]. For example, complex guidelines and uncertainty around the risk of transmission of primary brain malignancies from donor to recipient may have resulted in 23 missed donor opportunities where the transmission risk was subsequently ascertained to be low [4].…”