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Losing potential organ donors in critical care units: data from the Donor Action Database

Introduction

The aim was to analyze heart-beating organ donation patterns in four countries using the Donor Action (DA) Program [1] nationally, to identify bottlenecks in their donation process and suggest areas for improvement.

Methods

A retrospective medical record review (MRR) of all critical care deaths between January 2006 and December 2007 (n = 18,118) from 166 hospitals in 381 critical care units from Belgium, Finland, France and Switzerland was made using the DA's Diagnostic Review process. The upper age limit for medical suitability was 75 years. Data were entered into the DA System Database for analysis.

Results

From 6,561 patients (36.2% of all records) with no absolute contraindications to donation, 2,973 (45.3%) met preconditions for brain death (BD) diagnosis, 2,063 had signs of severe brain damage and 1,891 met criteria for formal BD diagnosis (= potential donors). Belgium had the utmost number of patients with formal BD diagnosis (75.7%), and Switzerland (57.4%, P < 0.0001) the lowest. Although donor identification rates were higher in France (93.6%) with the lowest in Finland (47.7%, P < 0.0001), Finland excelled in donor referral (93.9% of identified cases) vs. only 63.8% in Switzerland (P < 0.0001), and excelled in family approach rates (92.7%) vs. only 70.2% in France (P < 0.0001). Consent rates as a percentage of families approached were superior in Belgium and Finland (89.5%), with the most inferior in France (65.7%, P < 0.0001). Conversion rates as a percentage of potential donors vs. actual donors were higher in France (43.1%) and Belgium (42.9%) and were significantly lower in Finland (34.9%) and Switzerland (33.5%) (P = 0.0187). Only Belgium had a nonheart-beating donation policy during the study period, resulting in 11.2% more donors added to the country's donor pool.

Conclusion

The DA MRR proved to be an excellent tool to identify areas of improvement within certain steps of the donation pathway, such as donor identification, BD diagnosis, donor referral, family approach and obtaining consent. Moreover, the DA MRR has shown to be applicable in different countries and environments and should be considered a unique tool for comparing countries' donation performance.

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Roels, L., Spaight, C., Smits, J. et al. Losing potential organ donors in critical care units: data from the Donor Action Database. Crit Care 13, P78 (2009). https://doi.org/10.1186/cc7242

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Keywords

  • Brain Death
  • Medical Record Review
  • Donor Action
  • Critical Care Unit
  • Donation Policy