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Next-of-kin consent is key to increasing donation rates, Australia

Australia’s processes for identifying potential organ donors in hospitals is working well, but low next-of-kin consent rates continue to impede higher donation rates, according to research published in the Medical Journal of Australia.

In 2008, the Australian Government set up the National Reform Programme (NRP) to establish the “world’s best practice” in organ and tissue donation.

Part of the NRP was the DonateLife Audit, which aims to report on all actual and potential organ donation activity – donor identification, request and consent rates; reasons why donation does not proceed; and missed donation opportunities.

The DonateLife Audit collects data on all deaths of patients aged between 28 days and 80 years in the emergency department (ED) and intensive care unit (ICU). Researchers from the Royal Prince Alfred Hospital (RPAH), which contributes data to DonateLife, conducted a 6-month audit of all deaths in the hospital – including general ward deaths not covered by DonateLife Audit – to determine whether potential organ donors were being missed by the DonateLife Audit.

“Although the deceased organ donor rate is increasing in Australia, it is substantially lower than the highest performing countries (eg. Spain)”, Associate Professor Michael O’Leary, an intensive care specialist at RPAH, wrote.

“For this reason, we believed that more should be done to identify potential organ donors.”

A/Prof O’Leary and his co-authors collected data on 427 deaths at RPAH over a 6-month period in 2012. Nine were neonates under 28 days and therefore excluded. Another 175 were excluded because they were 80 years or older. Seventy-eight were excluded on the basis of active cancer or palliative care for cancer. Another 143 were excluded for other medical reasons.

The remaining 22 patients were assessed further. Of them, 12 patients had been referred to the DonateLife team for consideration for organ donation, of whom three became organ donors.

There remained 10 patients where a clear reason to exclude them from organ donation was not established and these patients’ records were assessed by organ donation specialists. Of these 10 patients, eight died on the general wards and of these there were three that might have become organ donors, but they would have required mechanical ventilation solely for the purpose of facilitating organ donation.

The hospital audit was compared to the DonateLife Audit, which during the study period identified 16 deaths of patients who could potentially have become organ donors. These 16 patients included all 12 patients identified in the study as referred to the DonateLife team, the three patients from the expert panel review, as well as one patient from the group of excluded deaths.

Dr O’Leary and his coauthors concluded that the DonateLife Audit is doing a good job of identifying potential organ donors.

“Extending its scope beyond the ICU and ED would not achieve a substantial increase in identification of potential donors”, they wrote.

“It appears that the principal factors affecting the lower organ donation rate in Australia compared with countries such as Spain are the lower rates of brain death and consent.

“Maximising consent rates is likely to be the single most effective intervention to increase organ donor numbers within existing medical practice in Australia.”

Source

Are potential organ donors missed on general wards? A 6-month audit of hospital deaths, Jonathan J Gatward MB ChB, FRCA, FCICM, Michael J O’Leary MD, FRCA, FCICM, Myra Sgorbini MN(Hon), Paul R Phipps PhD, FRACP, FCICM, Medical Journal of Australia, doi: 10.5694/mja14.00316, published 2 March 2015.

Source: Australian Medical Association