A practical approach to evaluate the potential donor pool and trends in cadaveric kidney donation

Background. The potential supply of transplantable cadaver kidneys is often expressed as donors per million population (pmp), which ignores some essen tial factors governing organ donation. Methods. We performed a modeled analysis of kidney donor extraction rates b y age, gender, race, cause of death, geographic region, and year in a cohor t of evaluable deaths and actual cadaver donors between the ages of 1 and 6 5 years (1988-1993). Evaluable death was defined as an in-hospital death in patients between the ages of 1 and 65 years whose ICD-9-CM cause of death was not an obvious contraindication to kidney donation, The main outcome me asures were the crude donation rate and an adjusted donor extraction rate ( DER) per 1000 evaluable deaths. Results. A total of 1.4x10(6) in-hospital deaths produced 300,502 evaluable deaths and 20,575 actual donors, Between 1989 and 1993, DER increased from 61.1 to 75 per 1,000 evaluable deaths. DERs were highest among the younges t age groups, declining significantly with age from 405.0 to 16.7/1,000 eva luable deaths for age groups 1-10 and 56-65 years, respectively. There was a small difference in donors pmp between blacks and whites (15 vs. 18), In contrast, DER was seven times higher in whites compared with blacks (112.5 vs. 16.5/1,000 evaluable deaths; P<0.001), The crude donation rate (per 1,0 00 evaluable deaths) was high for stroke (604.8) and trauma-related deaths (230.6), resulting in highly efficient donor extraction from these deaths, Region-specific DERs ranged from 49.4 to 83/1,000 evaluable deaths and diff ered significantly from the corresponding donors pmp, Conclusions. Estimating kidney donation relative to in-hospital evaluable d eaths is a meaningful measure of organ procurement efficiency. Efforts to e nhance cadaveric kidney donation should seek to understand and reduce the m arked demographic and regional disparity in donor extraction rates.