[Cornea donation: improving hospital coordination]. / Prélèvements de cornées: améliorer les performances d'une coordination hospitalière.

PURPOSE: To evaluate the impact of procedures developed to increase cornea donation in a general hospital. Comparative study before and after intervention. Since february 2002 all cases of intra-hospital death were considered by the hospital coordinator. A written selection protocol for potential donors was adopted and telephone interviews to obtain family consent were conducted using a standardized procedure. METHODS: The number of deaths in the institution, deaths considered by the hospital coordinator, clinical contraindications to harvesting, potential donors, face-to-face interview and telephone contact with families, the donation acceptance rate during telephone and face-to-face interviews, and the number of donors and corneas actually collected were recorded before and after intervention. The data were analyzed during two consecutive periods: Period 1, february 2001 to january 2002 (before protocol), and period 2, february 2002 to january 2003 (after protocol). RESULTS: The number of deaths in the institution was similar for the two periods. The increase in deaths considered by the hospital coordinator and the decrease in contraindications resulted from increasing the pool of potential donors from 188 to 401 (p < 0.001). The number of telephone interviews increased from 33 to 274. The rate of family consent given during face-to-face interviews was similar, 61% versus 72% (p = 0.1), but acceptance during telephone interviews increased from 15% to 60% (p < 0.001) and 138 corneas were collected in period 1 and 443 in period 2. The rate of cornea donors increased from 6% to 20% of the hospital's deaths. CONCLUSION: The consideration of all hospital deaths, the use of a written protocol of contraindications for cornea donation and the wide use of telephone interviews to obtain family consent led to a dramatic increase in cornea donation.

Rates of potential and actual cornea donation in a general hospital: impact of exhaustive death screening and surrogate phone consent.

BACKGROUND: In France at the end of 2002 the number of patients waiting for corneal grafts exceeded the number performed including the specimens imported from abroad. The major reason for the lack of grafts is that potential donors are not exhaustively identified and surrogate consent is difficult to obtain. This study reports the rates of potential cornea donation in a general French hospital when a transplant coordination team screened all deaths and made extended use of the phone to obtain familial consent. METHODS: All deaths in our institution were registered from February 2002 to January 2003. During this period, the transplant coordination team recorded on a daily basis the circumstances of death, medical contraindications, logistical problems, the consent rate, and the way patients' families were approached, namely, face-to-face or by phone interview. RESULT: Among 1088 deaths, 687 (63.1%) were unsuitable for corneal donation. All of the remaining 401 (36.9%) patients were considered for donation. Three hundred fifty four surrogates were interviewed by the transplant coordinator. In only 47 cases (18%) was it impossible to inform relatives and obtain donation consent. Two hundred seventy four families (77.4%) were contacted by phone (acceptance rate 60%) and 80 (22.6%) during a face-to-face interview (acceptance rate 72%). The acceptance rate was 62.7%. Finally, 443 corneas were retrieved, which represented 20.4% of institutional deaths. CONCLUSIONS: In a general hospital, systematic registration of deaths led to selection of 36.9% as potential corneal donors. The use of phone interviews allowed us to perform a procurement in 20.4%.