IMPROVEMENT IN THE ORGAN DONATION RATE AT A LARGE URBAN TRAUMA CENTER

Objective: To implement and then determine the efficacy of a ''hospita l development'' (HD) plan designed to increase organ donation rates at an urban trauma center. Design/Setting: Retrospective reviews of all deaths at an urban, level I trauma center for 1991 to 1994. Subjects: Potential organ donors were identified by standardized criteria, and t he reasons why potential donors did not become actual organ donors ('' nonproductive donors'') were categorized. Actual donors were defined a s individuals in whom one transplantable organ was recovered. Results also were expressed as percentages of potential donors for each year. Changes in actual donor numbers and in nonproductive donor categories were compared for the ''pre-HD'' (1991-1992) and ''post-HD'' (1993-199 4) periods. Intervention: The HD plan had six components: identificati on of key contact individuals, development and modification of relevan t hospital policies, improvement in procurement agency visibility in h ospital units, education of hospital staff regarding organ donation, i nstitution of early on-site donor evaluations, and provision of feedba ck to hospital staff about the disposition of potential organ donors. Results: Institution of the HD plan was associated with a highly signi ficant increase in actual donors for the post-HD period as compared wi th the pre-HD period (P<.001), and pre-HD and post-I-ID donor rates we re 26.1% and 49.5%, respectively. This increase was due primarily to a marked improvement in hospital staff identification and referral of p otential donors (P<.001). Conclusions: A coordinated plan incorporatin g continuing staff education, organ donation policy refinement, and in creased visibility and availability of organ procurement agency person nel can substantially increase organ donation at an urban trauma cente r.