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Improving donor identification with the Donor Action programme

  • Original Article
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Transplant International

Abstract.

The increasing demand for organs for transplantation entails a consensual need for enhancement of organ procurement activity. As organ donors reside mainly in hospital intensive care units (ICUs), the Donor Action programme is aimed at identifying critical areas in ICUs, in order to improve the first step of organ donation. The purpose of this paper is to analyse the problem of identification of potential donors by means of a chart revision of patients who died in 14 ICUs in the Emilia-Romagna region between 1 July 1998 and 31 December 2000. All deaths and patients with severe brain insult (score on Glasgow Coma Scale (GCS) = 3/15) were assessed by the local transplant co-ordinators together with a professional at the Transplant Reference Centre. Brain death diagnoses and potential donor referrals were therefore assessed in the study period, which was subdivided into five semesters. Of the 3,056 deaths reported in 30 months, 1,248 were due to severe brain damage (GCS score = 3). Brain death diagnosis (BD) was performed in 509 patients (40.8%). Although we applied the same parameters over the whole length of the study, we observed a significant increase in BDs (from 87 in the first semester to 125 in the last, 30.5% to 53.0% of the patients with GCS 3 (P=0.003, χ2 for trend=16.072), in spite of a slight decrease in the total number of deaths and in the total number of patients with GCS score = 3 (from 649 to 587, and from 44% to 41%, respectively). Study population characteristics could have contrasted with rather than facilitated our results: age and gender did not change significantly, whilst cause of death showed a significant reduction in trauma and an increase in cerebrovascular incidents over the whole length of the study. We can conclude that the more careful assessment of patients dying in ICUs, by the Donor Action programme, significantly contributed to the improvement of BDs observed in the study period. Therefore, Donor Action seems to be an efficient quality control programme to improve identification of potential donors, the first stage of organ procurement.

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Acknowledgements.

We are grateful to the staff of the 14 intensive care units who collaborated with the registration of the charts in this study: Dr. A. Pigna, Sant'Orsola Hospital, Bologna; Drs. C. Festa, G. Gambale, Maggiore Hospital, Bologna; Drs. M. Zanello, M. Neri, Bellaria Hospital, Bologna; Dr. R. Foppoli, Carpi Hospital; Drs. S. Bucci, F. Cocciolo, G. Pugliese, Cesena Hospital; Dr. P. Casalini, Faenza Hospital; Dr. G. Mantovani, Ferrara Hospital; Dr. P. Gudenzi, Forlì Hospital; Drs. C. Vaccari, D. Iseppi, Modena Hospital; Dr. M. Mergoni, Parma Hospital; Dr. A. Garelli, Ravenna Hospital; Drs. L. Favilli, M. Salsi, Reggio Emilia Hospital; Drs. A. Corsi, F. Bruscoli, Rimini Hospital.

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Authors and Affiliations

  1. Transplant Reference Centre, Emilia Romagna Region, Sant' Orsola Hospital, Clinica Chirurgica 2, Via Massarenti 9, 40138 Bologna, Italy

    Maria Rosa Pugliese, Daniela Degli Esposti, Nicola Venturoli, Paolo Mazzetti Gaito & Lorenza Ridolfi

  2. Internal Medicine Department; University of Bologna, Bologna, Italy

    Ada Dormi

  3. Nephrology Department, University of Bologna, Bologna, Italy

    Andrea Buscaroli

  4. Regional Health Department, Bologna, Italy

    Kyriakoula Petropulacos

  5. National Transplant Center, Rome, Italy

    Alessandro Nanni Costa

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  1. Maria Rosa Pugliese
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  2. Daniela Degli Esposti
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  3. Ada Dormi
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  4. Nicola Venturoli
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  7. Kyriakoula Petropulacos
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  8. Alessandro Nanni Costa
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  9. Lorenza Ridolfi
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Correspondence to Maria Rosa Pugliese.

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Pugliese, M.R., Degli Esposti, D., Dormi, A. et al. Improving donor identification with the Donor Action programme. Transpl Int 16, 21–25 (2003). https://doi.org/10.1007/s00147-002-0497-7

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  • DOI: https://doi.org/10.1007/s00147-002-0497-7

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