Deceased Organ Donation has Increased in New Zealand: Success of a quality improvement program

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Abstract

Introduction

Deceased organ donation has increased in NZ. In 2016 there were a record 61 donors (13.3 dpmp) compared with 53 in 2015, 46 in 2014 and an average of 38 (8.7 dpmp) for a 6-year baseline period 2008-2013 (p < 0.003 for 2016 vs baseline). ODNZ hypothesised that the increase related to its recent quality improvement program.

Method

The quality improvement program is based on an ongoing nationwide audit of all ICU deaths since 2008 and has the co-operation of staff in the 24 public hospital ICUs. Analysis of “possibly brain dead” patients (PossBD; defined as ventilated, pupils fixed and dilated, no sign of brain stem activity at time of death) for 2008-2010 showed variation between ICUs in several clinical donation-related activities. The program commenced in 2011 with visits to individual ICUs showing their own data in comparison with other ICUs; and with regular national audit meetings for ICU staff where latest data was presented, education was provided, and selected cases were discussed. It was supplemented by an on-line system of filters and alerts to enable staff to identify, discuss and report missed opportunities for potential donation. Additionally, the nursing role in donation expanded and the availability of ODNZ medical specialists to discuss cases and issues increased.

Results

The increase in donors occurred within a similar number of PossBD in 2008–2016 (median 138, range 115-162). Family agreement when donation was formally discussed averaged 55% and was similar across years (median 56%, range 45-68%). Amongst the PossBD in 2008-2016, the rates of mention of organ donation rose from 57% to 80%, discussion with ODNZ from 36% to 72%, testing for brain death from 51% to 73%, formal discussion about organ donation from 50% to 77% and family agreement to donation from 26% to 44%. The changes were unequal across ICUs. The total number of telephone discussions with ODNZ about potential donation rose steadily from 70 in 2008 to 168 in 2016.

Conclusion

ODNZ concludes that the donor increase reflects increased ICU staff awareness of potential opportunities, followed by increased consultation with ODNZ and an increase in families offered donation, rather than families agreeing more often when offered. We aim to continue this program and achieve change in all ICUs.

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