Potential for cadaveric organ retrieval in New South Wales.

the study hospitals was the same as in the other New South Wales hospitals, the projected donor rate for New South Wales was 18/million population/year (10 to 26); the projected missed potential donor rate was 15/million population/year (7 to 23); and the projected rate of potential donors with permission refused was 18/million population/year (10 to 27).

Conclusions--The donor rate could be increased 70%-80% by overcoming the reluctance of medical practitioners to resuscitate missed potential donors and increased further by gaining permission for organ retrieval from the next of kin.

Introduction

The supply of donor organs limits the number of organ transplantations carried out. This limitation applies especially to renal transplants, where maintenance dialysis allows the number of prospective recipients to increase faster than the supply of donor organs. In Australia live donors contribute about 7.8% of renal kidneys for transplantation and less than 1% of livers for transplantation.[1] The majority of organs therefore comes from cadaveric donors. In the past five years rates of kidney donation from cadavers were 12.3/million population/year in Australia and 11.6/million population/year in New South Wales.[1] These rates were lower than those in the United Kingdom (14.5/million population/year)[2] and the United States (16/million population/year)[3]

Demand for transplanation exceeds organ supply in all countries with established transplantation programmes. It has been suggested, however, that supply would be adequate if all potential donors became actual donors.[4] Few comprehensive studies have measured this difference between potential and actual donor rates. Gore et al studied intensive care units and Gentleman et al audited a neurosurgical unit.[256] None of these studies considered other areas in the hospital where brain death might occur, such as the coronary care department, primary and emergency care units, or neurology departments. Salih et al surveyed 21 hospitals: the likelihood of a patient becoming a potential donor was not decided by clinicians.[7] Hence the New South Wales Histocompatibility Committee, which coordinates solid organ transplatation in New South Wales, undertook a study to address three questions: (a) What is the potential for cadaveric organ retrieval in New South Wales? (b) What are the reasons for potential donors failing to become actual donors? (c) Can the actual donor rate be increased by educational intervention among health care providers caring for potential donors? In this paper we answer the first two questions.

Methods

STUDY DESIGN

The study consisted of a prospective audit of the medical records of all patients who died in five hospitals (study hospitals) in the 12 month period from 1 December 1989 to 30 November 1990. Permission to carry out the study was obtained from the Department of Health in New South Wales and the ethics committees of the hospitals.

MEASUREMENTS

A research assistant, in consultation with a nominated medical specialist from each hospital, abstracted and coded data from each medical record on to a data entry form. Data collected included the causes of death, whether a patient was a potential donor, the classification of the potential donor at …