Donor action. A quality assurance program for intensive care units that increases organ donation

Donor Action (DA) is an international initiative that helps intensive care units (ICUs) improve donation. Existing best practices from around the worl d have been incorporated into this quality assurance program. Following a v alidated diagnostic review, areas of weakness in donation practices are ide ntified and the appropriate changes introduced. Corrective measures have be en developed in the form of five "core" program modules which correspond to critical steps in the donation process and can be used together or alone a ccording to specific identified needs. Medical records review (MRR) and hos pital attitude surveys (HAS) were performed in 11 ICUs in Spain (2), The Ne therlands (2), the United Kingdom (1), and Canada (6). Baseline data were g athered on the units potential for donation, staff attitudes toward donatio n, and self-reported skills/confidence in performing a range of donation ro les. Analysis of these data were used to customize the program to individua l ICU requirements, MRR data from 579 cases showed a 69% (398) potential fo r donation from which only 31% (124) were realized. Detection and managemen t failures (166; 42%) and refusal to donate (104; 26%) were the major reaso ns for loss of potential donors. The HAS returns from staff (2,129) showed consistently strong perceptions that organ donation saves lives (97%) Suppo rt for donation (94%) and willingness to donate their own organs (79%) were high in all country samples. Ratings of skills/confidence were highest for comforting the family (70%), with much lower comfort levels reported on ex plaining brain death (44%), introducing organ donation (38%), and presentin g a family with the option for donation (31%). Following introduction of th e appropriate program modules, a sustained (2-year) effect of a 33% increas e in donation rates is demonstrated. The Donor Action HAS and MRR are usefu l tools in identifying problems within the donation process and lead to the introduction of improvement strategies integral to the Donor Action progra m that result in an increase in organ donation.