The problem of organ donation: Improving the rate of consent and actual donation in critical care units of Urban trauma centers

Introduction: As of August 1999 there were 65,011 patients on the UNOS national transplant waiting list; in 1998 4855 patients died while on waiting lists. Still, only 15% to 20% of potential organ donors become actual donors. With head trauma as a major cause of death among potential organ donors, it is clear that the management of potential donors must become a high priority for trauma and critical care teams if donation rates are to improve. We hypothesized that the use of a nuclear medicine flow scan (NMFS)to rapidly and objectively determine brain death would improve consent and donation rates. Methods: Data was prospectively collected from six urban trauma centers (A - F) in Philadelphia in 1998. The calculation of the number of potential organ donors and consent for donation was done by the local Organ Procurement Organization to whom reporting of all deaths is mandatory by state law. Only Center A uses NMFS routinely in their brain death protocol. Data was analysed with Fisher's Exact Test. Results: Center A had significantly higher consent and donation rates compared to the other five centers combined results. (See Table) Conclusion: The routine use of NMFS as part of a rapid brain death protocol is associated with an increased consent and donation rate at an urban trauma center hi this study. Previous work has shown that the use of NMFS reduces the time to brain death determination in one institution. Further prospective randomized study is necessary to determine whether these results are directly related to the use of the NMFS, the shortening of the time to determination of brain death, or a phenomenon related to other factors. Organ Donation Variables at Six Urban Trauma Centers Trauma Center Potential Donors Identification Approach Consent Donation A 36 100% 83% 63% a 53% a B-F 123 94% 86% 35% 29% a= p<0.01.