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Table 1 Summary of study characteristics and outcomes

From: Interventions aimed at healthcare professionals to increase the number of organ donors: a systematic review

Study, year, country [reference]

Study design

Intervention and setting

Population, n

Intervention(s) vs. control(s)

Outcome

Effect

p value

Intervention

Control

Intervention

Control

Additional group

Adanir et al. 2014, Turkey [12]

RCT

Psychological support for relatives of patients at one general ICU

First-degree relatives of 100 ICU patients

First-degree relatives of 100 ICU patients

Psychological support vs. no psychological support

Consent rate if patient had become brain dead, %

75

32

 

< 0.0001

Consent rate if patient died, %

78

13.9

 

< 0.0001

Beasley et al. 1997, USA [13]

UBA

A large-scale intervention for physicians, residents, nurses, social workers, chaplains and administrators in 50 hospitals in three OPO service areas

369 potential donors

422 potential donors

After vs. before intervention

Donor identification, %

97.0

90.5

 

0.001

Referral rate, %

80.2

55.5

 

0.001

Donation requested, %

85.6

69.0

 

0.001

Family consent rate, %

52.2

50.9

 

NS

Donation rate, %

42.5

32.9

 

0.005

Beigee et al. 2017, Iran [14]

UBA

More active identification of brain dead cases in hospitals (n = NR) affiliated to organ procurement units of Shahid Beheshti University of Medical Sciences

NR

NR

After vs. before intervention: from calling a couple of times per week to calling every day

Reported cases of brain death, n

460

224

 

NR

Number of confirmed cases of brain death, n

306

180

 

NR

Number of cases transferred to the OPU, n

188

125

 

NR

Actual number of donors, n

165

115

 

NR

Family consent rate, %

90%

75%

 

< 0.001

Number of donated organs per each brain-dead case, n

2.74

2.67

 

NR

Bires 1999, USA [15]

Cohort study

An 8-h designated requestor program implemented in one hospital;13 requestors were trained

19 potential donors before, 20 after

9 potential donors before, 15 after

Hospital with designated requestors vs. hospital with organ procurement coordinators

Consent rate before intervention, %

58

66

 

NR (1.000a)

Consent rate after intervention, %

50

60

 

NR (0.734a)

Bleakley. 2010, UK [16]

UBA

Donor identification scheme and training of 170 staff members in four hospital sites

NR

NR

After vs. before intervention

Number of referrals, n

121

4

 

NR

Number of successful organ donors, n

9

0

 

NR

Number of organs transplanted, n

22

0

 

NR

Feest et al. 1990, UK [17]

UBA

Protocol to detect and transfer potential organ donors to the ICU for organ donation implemented in one hospital

18 donors

3 donors

After vs. before intervention

Donors derived outside ICU, n

8

0

 

NR

Donors from ICU, n

10

3

 

NR

Possible donors where donation was not discussed, n

4

8

 

NR (0.005a: total number of donors from possible donors)

Garside et al. 2012, UK [18]

UBA

An embedded specialist nurse in organ donation (SNOD) and utilization of a collaborative care pathway in one hospital

160 ED deaths

151 ED deaths

After vs. before intervention

Referral to organ donation team from ED, n

26

3

 

< 0.0001

Patients proceeding to organ donation from ED, n

2

0

 

1.0

Referral to organ donation team from ICU, n

44

9

 

NR

Henderson et al. 1998, USA [19]

UBA

Educational campaign of emergency personnel in one hospital

1995: 25 potential donors, 1996: 45 potential donors

10 potential donors

One year after intervention (1995) vs. before intervention vs. 2 years after intervention (1996)

 

1995

1994

1996

1995 vs. 1994

Referral to OPA from ED, % of potential organ donors

100

10

100

< 0.0001

Organs procured from ED, n

14

0

32

NR

Actual donors from ED, n

NR

0

10

NR

Ismail et al. 2018, Netherlands [20]

Cohort study

A telephone-based advisory support by an experienced trained psychologist for requesters who are about to request for donation.

141 requestors with intervention

1563 requestors without intervention

Intervention vs. control

Consent or assent rate potential donors

58%

35%

 

< 0.001

Consent or assent rate potential donors not registered in DR

44%

19%

 

< 0.001

Consent rate potential donors who leave decision to next of kin

31%

30%

 

> 0.99

Assent rate potential donors registered with permission in DR

93%

91%

 

0.78

Jansen et al. 2011, Netherlands [21]

NRCT

Nurses were trained in communication about donation and have long-term contact with relatives of potential donors in one hospital

1 hospital (66 relatives)

2 different control hospitals (107 relatives vs. 99 relatives)

Hospital with trained donation practitioners (TDP) vs. control hospital vs. control hospital with hostesses

 

TDP

Control

Hostess

 

Consent rate including consent in Donor Registry, %

57.5

34.6

39.4

0.003 (TDP vs. control)

 

0.022 (TDP vs. hostess)

Consent rate excluding consent in Donor Registry, %

45.1

21.7

26.3

0.004 (TDP vs. control)

 

0.026 (TDP vs. hostess)

Consent rate organ donation, %

60.0

32.7

 

< 0.022

Krekula et al. 2014, Sweden [22]

CBA

Donation specialist nurses (DOSSes) who support the local team with the medical care of eligible donors; 7 DOSSes were appointed in a large urban county

96 eligible donors with DOSS participation

15 eligible donors without DOSS participation, 59 before DOSS service

DOSS participated vs. DOSS did not participate vs. before intervention

 

DOSS

No DOSS

Before

DOSS vs. no DOSS

Donation rate, %

74

20

37

0.001

Reason for not becoming actual donors: family vetoes, %

14

60

34

0.001

Reason for not becoming actual

donors: non-willingness deceased, %

7

20

5

NR

Lenzi et al. 2014, Brazil [23]

Cohort study

Requesting donation by OPO professional (intervention), In-Hospital Coordinator (IHC) or ICU physician in Rio de Janeiro, Brazil

167 (2011) and 248 (2012) OPO

63 (2011) and 55 (2012) ICU;

55 (2011) and 108 (2012) IHC

OPO vs. ICU (not trained) vs. IHC

 

OPO

ICU

IHC

 

Consent rate 2011, %

63.5

12.7

41.8

53.7

NR (< 0.001a)

NR (< 0.001a)

Consent rate 2012, %

64.5

20.4

  

Linyear et al. 1999, USA [24]

UBA

Implementation of a systematic hospital-based program at Virginia Commonwealth University

Post 1997: 27 potential donors

Post 1998: 20 potential donors

42 potential donors

After intervention 1997 vs. before intervention vs. after intervention 1998

 

After 1997

Before

After 1998

 

Referral rate, %

93

95

90

NR (0.734a)

Approach rate, %

93

88

90

NR (0.833a)

Consent rate, %

44

49

72

NR (0.153a)

Donation rate, %

26

36

50

NR (0.235a)

Manyalich et al. 2012, international [25]

UBA

Training program implemented in 220 hospitals in 16 countries

1101 declared brain deaths

784 declared brain deaths

After vs. before intervention

Utilized donors identified, mean ± SD (range)

20.0 ± 17.1 (1–78)

15.7 ± 14.3 (2–69)

 

0.014

Organs recovered, mean ± (range)

59.3 ± 52.2 (2–247)

49.7 ± 48.6 (0–228)

 

0.044

Mulvania et al. 2014, Australia [26]

UBA

Customized, self-sustaining training program area in Australia

NR

NR

3 years during implementation (2011–2013). Pilot program started October 2011.

 

2013

2011

2012

 

Number of deceased brain dead donors, n

391

337

354

NR

Request rate, %

96

94

92

 

Consent rate, %

62

59

61

NR

NR

NR

Conversion rate, %

53

49

51

Sandiumenge et al. 2018, Spain [27]

UBA

An instant messaging application (WhatsApp@) was implemented in order to refer potential donors to the DC

74 potential donors outside ICU

40 potential donors outside ICU

After vs. before intervention

 

After

Before

  

Referral of possible donors to DC from outside ICU

62%

32%

 

< 0.05

Proportion donors outside ICU from BD donors in hospital

29%

13%

 

< 0.05

Siminoff et al. 2009, USA [28]

UBA

Training program ‘Communicating Effectively About Donation’ in 17 hospitals

325 eligible donors

134 eligible donors

After vs. before intervention

Consent rate, %

55.5

46.3

 

0.07

Time-sensitive referrals, n (% of eligible donors)

281 (86.5)

116 (86.6)

 

0.97

Siminoff et al. 2015, USA [29]

RCT

Online training program ‘Communicating Effectively about Donation’ in 9 OPOs. CEaD1: theoretical. CEaD2: theoretical and practical (Table 1).

CEaD1: 558 requests, CEaD2: 368 requests

677 requests

After CEaD1 vs. before intervention vs. After CEaD2

 

CEaD1

Before

CEaD2

CEaD1 vs. CEaD2

Consent rate, %

83

84

86

NS

Consent rate novice, %

80

78

89

0.03

Consent rate midlevel, %

76

81

88

0.004

Consent rate senior, %

92

89

83

0.02

Stark et al. 1994, USA [30]

UBA

Nurse requestor educational program in one hospital; 25 requestors were trained

11 potential donors

15 potential donors

After (1993) vs. before (1991) intervention

Referrals/requests, n (%)

11 (100)

10 (67)

 

NR (0.053a)

Consent/donations, n (%)

8 (73)

4 (27)

 

NR (0.198a)

Von Pohle et al. 1996, USA [31]

Cohort study

Decoupled presentation of the option of organ donation by OPO representative in one hospital

34 potential donors

47 potential donors

After vs. before intervention

Donation rate, %

59

38

 

< 0.05

Young et al. 2009, UK [32]

RCT

Collaborative requesting by potential donor’s clinician and donor transplant coordinator in 79 ICUs in the UK

100 relatives

101 relatives

Collaborative requesting vs. routine requesting by the clinical team alone

Consent rate intention to treat, %

57

62

 

0.53

Consent rate per protocol, %

67

60

 

0.33

Zier et al. 2017, USA [33]

UBA

Implementation of an electronic decision support system to identify patients who meet OPO notification criteria in one hospital

30 patients meeting trigger criteria

58 patients meeting trigger criteria

After vs. before intervention

Time to referral, hours (range)

1.7 h (0–23.2 h)

30.2 h (0–288.5 h)

 

0.015

Donor conversion rate, %

9/10 = 90%

6/12 = 50%

 

0.074

Proportions of notifications occurring ≤ 1 h, %

70%

36%

 

0.003

Median time to notification, hours

< 0.01 h

3.5 h

 

0.001

Total organ donors/critical care death, %

11/24 = 46%

7/57 = 12%

 

0.002

  1. Abbreviations: RCT randomized controlled trial, ICU intensive care unit, UBA uncontrolled before-after study, OPO organ procurement organization, NS not significant, NR not reported, SNOD specialist nurse in organ donation, ED emergency department, OPA organ procurement agency, NRCT non-randomized controlled trial, TDP trained donation practitioner, DOSS donation specialist nurse, CBA controlled before-after study, IHC in-hospital coordinator, CEaD communicating effectively about donation
  2. ap value was not reported in article, but was calculated based on the outcomes and number of participants given