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Excerpt
Purpose: Recent evidence suggests that only 35% of the total organ donor pool is realized. To improve hospital practices and maximize donation, policies focusing on hospital practices are needed at the national, regional, and hospital levels.
Methods: The Partnership for Organ Donation aims to increase organ donation by diagnosing barriers to donation and focusing interventions on modifiable practices that can lead to higher rates of donation. Specific methods include: retrospective review of medical records; prospective tracking of organ donation requests; interviews of donor and non-donor families; surveys of critical care staff involved in organ donation; hospital-focused interventions, analysis of policy initiatives.
Results: Recently published research confirms that over one-fourth of potential donor families are not asked to donate. Nationally, consent rates hover around 50% even though consent can reach 74% if optimal request processes are utilized. However, fewer than one third of potential donor cases proceed optimally. Research among donor and non-donor families confirms that hospital process strongly influences donation decisions, and that non-donor families have less satisfactory experiences in hospitals than donor families. While models exist that lead to higher rates of donation in hospitals, broad-based systemic improvement is unlikely if hospitals are improving practices only voluntarily. Regulation and legislation can increase hospitals' focus on donation results, and provide incentives for good donation practices and penalties for poor donation practices.
Conclusion: Donor hospitals in the US lack consensus about best practices in donation, and are not held accountable for donation outcomes. Policies, whether national, regional, or local should focus on the following areas: Benchmarking of donation potential and outcomes to track donor effectiveness and establish regional and national performance goals and accountability for hospitals and OPOs; Consistent referral practices to ensure that all eligible deaths are referred to the OPO; Formalized protocols for family communication based on family needs and current research; Training and certification for hospital staff involved in donation. Societies such as ASTS and ASTP can play productive roles by encouraging their members to demand best practices in their own institutions; by supporting regulation that focuses on hospital practice (such as the recent HCFA conditions of participation for hospitals); by supporting state legislation similar to the PA Law 102; by exercising leadership in the OPOs they govern; by providing input to accreditation organizations such as JCAHO.
