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 |