ABSTRACT
OBJECTIVE: To implement and then determine the efficacy of a "hospital development" (HD) plan designed to increase organ donation rates at an urban trauma center. DESIGN/SETTING: Retrospective reviews of all deaths at an urban, level I trauma center for 1991 to 1994. SUBJECTS: Potential organ donors were identified by standardized criteria, and the reasons why potential donors did not become actual organ donors ("nonproductive donors") were categorized. Actual donors were defined as individuals in whom one transplantable organ was recovered. Results also were expressed as percentages of potential donors for each year. Changes in actual donor numbers and in nonproductive donor categories were compared for the "pre-HD" (1991-1992) and "post-HD" (1993-1994) periods. INTERVENTION: The HD plan had six components: identification of key contact individuals, development and modification of relevant hospital policies, improvement in procurement agency visibility in hospital units, education of hospital staff regarding organ donation, institution of early on-site donor evaluations, and provision of feedback to hospital staff about the disposition of potential organ donors. RESULTS: Institution of the HD plan was associated with a highly significantly increase in actual donors for the post-HD period as compared with the pre-HD period (P < .001), and pre-HD and post-HD donor rates were 26.1% and 49.5%, respectively. This increase was due primarily to a marked improvement in hospital staff identification and referral of potential donors (P < .001). CONCLUSIONS: A coordinated plan incorporating continuing staff education, organ donation policy refinement, and increased visibility and availability of organ procurement agency personnel can substantially increase organ donation at an urban trauma center.
Subject(s)
Tissue Donors , Trauma Centers , Urban Health Services , Feedback , Hospital Administration , Humans , Medical Staff, Hospital/education , Nursing Staff, Hospital/education , Organizational Policy , Referral and Consultation , Retrospective Studies , Tissue Donors/statistics & numerical data , Tissue and Organ Procurement/methods , Tissue and Organ Procurement/organization & administration , Tissue and Organ Procurement/statistics & numerical data , Trauma Centers/organization & administration , United States/epidemiology , Urban Health Services/organization & administration , Washington/epidemiology , WorkforceABSTRACT
While current literature documents a critical disparity between the increasing demand for organs for transplantation and the relatively static supply, reasons for the shortage of donors are not well understood. Public opinion surveys describe a population willing to donate, but consent rates reported by organ procurement organizations suggest problems in the process of approaching families. This study of Texas physicians regarding their knowledge of laws related to brain death and to routine inquiry for organ donation and their attitudes toward the critical step of seeking consent from families indicates that physicians need more information about questions asked by families, would benefit from more structured hospital policies on routine inquiry, feel that physicians rather than nurses should approach families, and believe that the public is not well informed about donation.
