Lower frequency of organ donation at large general hospitals in Ontario than at hospitals with clinical programs for transplant recipients, points to missed opportunities to optimize organ donation, reveals a study published in CMAJ (Canadian Medical Association Journal). To understand whether organ donation rates differed between hospitals that treat transplant recipients and those that do not, researchers looked at all patients (adults and children) who died from catastrophic brain injury in Ontario between 1994 and 2011. After excluding small hospitals and ineligible patients, the study included 79 746 deaths at 56 hospitals and 1898 organ donors. Transplant hospitals accounted for 22 515 deaths and 1118 organ donors for a procurement rate of 5.0 per 100 deaths. In comparison, large general hospitals accounted for 57 231 deaths and 780 donors for a rate of 1.4 per 100 deaths.
"Our research suggests lower frequency of deceased organ donation at large general hospitals than at transplant hospitals," writes Dr. Donald Redelmeier, a physician at the Institute for Clinical Evaluative Sciences and the University of Toronto, with coauthors. The absolute reduction amounted to about 121 actual organ donors per year in large hospitals in Ontario and was accentuated among older patients. "Some of the shortfall may be explained by appropriate medical judgment, given that older organs are sometimes unsuitable for transplantation to young recipients. However, unfair age discrimination may be an additional explanation," write the authors.
Over the 17-year study period the number of actual donors increased steadily and was almost double comparing the last year to the first year. The average age of donors increased from about 40 to 51 years of age by the last year of the study. Men and women were equally represented. Patients aged 59 years or younger were about 10 times more likely to become actual donors than patients aged 60 years or older. Patients with lower socioeconomic status were about 30% less likely to become actual donors than patients with higher socioeconomic status. The most common condition leading to donation was brain death due to major trauma.
The authors suggest more training, education and improved policies around potential donors at large general hospitals in Ontario. Redelmeier and colleagues also stress, "Any of these approaches would require tact, is prone to misinterpretation and is rarely included in national campaigns for organ donation. The current data suggest, however, that prevailing practices lead to missed potential opportunities for solid organ donation in large general hospitals."