In 2001, the Organ Donation Breakthrough Collaborative was established to, among other reasons, encourage collaboration between the OPOs and donor and transplant hospitals .Although considerable increase in the number of organs available for transplantation has been realized since the collaborative began [5–9], acute shortage of organs continues to be a major challenge for the transplant community.
In the US (1997–1999), there were estimated 40,610 brain-dead potential organ donors but only 17,127 actual donors .
Poor relationship between key organizations including organ procurement organizations (OPOs) and hospitals in their donation service area (DSA) is one of the several reasons for this tragic loss of donors .
A process breakdown is defined as a deviation from the organ donation protocol that may jeopardize organ recovery. A retrospective analysis of donation-eligible decedents was conducted using data from an independent organ procurement organization.
Adjusted effect of process breakdown on organs transplanted from an eligible decedent was examined using multivariable zero-inflated Poisson regression. An eligible decedent is four times more likely to become an organ donor when there is no process breakdown (adjusted OR: 4.01; 95% CI: 1.6838, 9.6414; ) even after controlling for the decedent’s age, gender, race, and whether or not a decedent had joined the state donor registry.
Although there is a committed and a quality-oriented culture, competing priorities in the hospital and the inherent complexity of critical care can sometimes lead to deviations from the best practices.
OPOs identify these deviations as “process breakdowns.” While several studies have identified a relationship between process breakdowns and conversion rate (the actual number of organ donors divided by the number of eligible deaths) [11–15], it is unclear how process breakdowns affect the supply of viable organs. Consider the following: Using patient-level data from an OPO, we examined the effect of process breakdowns on the supply of transplantable organs.For each eligible decedent, information was retrieved on age, gender, race, hospital where death occurred, organ donor status, whether the decedent had joined the state donor registry (registered decedent), organs transplanted, and whether there was a process breakdown.The outcome variable of interest is the number of organs transplanted from an eligible decedent.Indeed all organ donors in our dataset had some organs recovered for transplantation irrespective of whether they were actually transplanted.We use the term “donor” in similar sense in this paper meaning that an eligible decedent may become a donor and still not yield any transplantable organs.In recent years critical pathways for organ donation have been developed to preserve the opportunity for donation.Critical pathways, also called “clinical pathways” or “care maps,” help standardize medical care, reduce variability, and improve outcomes of medical procedures .Consequently 6,508 patients died while waiting for a life-saving organ .Increasing the availability of transplantable organs is therefore critical in preventing deaths from end-stage organ failure.All data manipulation and analytic procedures were performed using Stata SE 13.0 (Stata Corp, College Station, Texas).Decedent records were extracted from CORE’s data system for analyses.