Abstract
Background
Lack of donor organ availability represents a major limitation to the success of solid
organ transplantation. The Scientific Registry of Transplant Recipients (SRTR) publishes
performance reports of organ procurement organizations (OPO) in the United States,
but does not stratify by the mechanism of donor consent, namely first-person authorization
(organ donor registry) and next-of-kin authorization. This study aimed to report the
trends in deceased organ donation in the United States and assess the regional differences
in OPO performance after accounting for the different mechanisms of donor consent.
Methods
The SRTR database was queried for all eligible deaths (2008-2019) which were then
stratified based on the mechanism of donor authorization. Multivariable logistic regression
was performed to assess the probability of organ donation across OPOs based on specific
donor consent mechanisms. Eligible deaths were divided into three cohorts based on
probability to donate. Consent rates at the OPO level were calculated for each cohort.
Results
Organ donor registration among adult eligible deaths in the U.S. increased over time
(2008: 10% vs. 2019: 39%, p<0.001), coincident with a decline in next-of-kin authorization
rates (2008: 70% vs. 2019: 64%, p<0.001). At the OPO level, increased organ donor
registration was associated with lower next-of-kin authorization rates. Among eligible
deaths with medium- and low-probability of donation, recruitment was highly variable
across OPO's, ranging from 36% to 75% in the medium-probability group (median 54%,
IQR 50% - 59%) and 8% and 73% in the low-probability group (median 30%, IQR 17% -
38%).
Conclusion
Significant variability exists across OPOs in the consent of potentially persuadable
donors after adjusting for population demographic differences and the mechanism of
consent. Current metrics may not truly reflect OPO performance as they do not account
for consent mechanism. There is further opportunity for improvement in deceased organ
donation through targeted initiatives across OPOs, modeled after regions with the
best performance.
Keywords
Abbreviations:
HRSA (Health Resources and Services Administration), OPO (Organ Procurement Organization), OPTN (Organ Procurement and Transplantation Network), SRTR (Scientific Registry of Transplant Recipients)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
December 28,
2022
Received in revised form:
December 6,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation.
