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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