ORGAN DONOR POTENTIAL AND PERFORMANCE - SIZE AND NATURE OF THE ORGAN DONOR SHORTFALL

Objectives: To estimate the potential for solid organ donation; to ide ntify modifiable reasons for nondonation. Design: Retrospective medica l records review. Setting: Sixty-nine acute care hospitals in four geo graphic areas of the United States in 1990, and a stratified random sa mple of 89 hospitals in three of the same areas and 33 of the same hos pitals in 1993. Patients: Patients less than or equal to 70 yrs of age who were brain dead and medically suitable for donation. Intervention s: None. Measurements and Main Results: Standard forms were used to re cord patient demographic and hospital information. Reasons for nondona tion were coded as ''not identified,'' ''family not asked,'' ''consent denied,'' or ''other.'' The main outcome measures were rate of donati on and rates of nonidentification, not asking, and nonconsent. Organ d onation occurred among 33% (299/915) of medically suitable cases ident ified in 1990 (95% confidence interval 30% to 36%). Ninety-four potent ial donors were not identified, 156 were not asked, 326 families denie d consent, and 41 potential donors were categorized as ''other,'' incl uding patients who had suffered a cardiac arrest, and medical examiner prohibition of donation. In the 1993 study, organ donation occurred i n an estimated 33% of suitable cases. In 1990, rates of donation were highest among patients <50 yrs of age, patients who died of traumatic causes, and non-Hispanic white patients. Logistic regression showed lo wer odds of donation for African American patients (odds ratio 0.38, 9 5% confidence interval 0.23 to 0.63) independent of potentially confou nding hospital acid patient variables (p = .0001). Donation rates did not vary by hospital size or type. Conclusions: Despite legal acid pol icy initiatives, only one third of potential donors became donors in 1 996, with similar results in 1993. Extrapolating the 1990 findings to the United States suggests a pool of 13,700 medically suitable donors per year. Prospective identification and requesting donation in all su itable potential donor cases could lead to 1,800 additional donors per year.