Improved Organ Procurement Through Implementation of Evidence-based Practice

Abstract

Michigan, like most other states in the nation, has a clear need for more organ donors for transplantation; at this time, there are more than 2,800 patients in the state awaiting organs. We have evaluated the effects of a process improvement program designed to increase the number of organ donors and the number of organs donated from appropriate trauma patients. In 2005, William Beaumont Hospital began working with the Michigan Hospital Association Keystone Center and more than 40 hospitals across Michigan to implement evidence-based practices in organ donation focused on 4 specific outcomes and process measures. Outcome measures were conversion rate and referral rate, whereas the process measures were timely notification rate and the rate of requests by appropriate requester. We have retrospectively reviewed our recent outcomes in regard to these measures and compared them with the outcomes for the same time period 1 year before implementation. The data for preimplementation (January-December 2004; 32 eligible donors) and postimplementation (January-December 2005; 30 eligible donors) are summarized below: [table: see text] In 2004, a total of 67 organs were made available to Gift of Life Michigan; in 2005, a total of 88 organs were made available, a 31% increase. Implementation of evidence-based practice initiatives can significantly increase the donor conversion rate. This has led to an overall increase in the number of organs available for transplant.

Breakdown in the Organ Donation Process and Its Effect on Organ Availability

“…Evidence from published evaluations of quality improvement initiatives undertaken by several OPOs suggests that there is an inverse association between process breakdowns and donation rate [ 11 – 15 ]. Burris and Jacobs found that a mandatory twenty-minute training for staff in nursing, patient and family services and pastoral care, and employing compliance monitoring tools resulted in an increase in the referral rate from 54 percent to 98 percent over a 10-month period.…”

“…In one study however, researchers did not find an association between timely referral/appropriate family approach and the conversion rate. Although implementing evidence-based best practices resulted in significant improvement in conversion rate (from 50 percent in 2004 to 80 percent in 2005), the referral rate, timely notification rate, and the appropriate requester rate did not show significant improvement [ 15 ]. However, since that study only included 32 eligible decedents in the preimplementation group and 30 eligible decedents in the postimplementation group, it probably lacked sufficient power to detect the small improvements.…”

“…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.…”

Strategies to increase organ donation: the role of critical care practitioners

“…If these clinical triggers are met, there should be a referral to the Specialist Nurse for Organ Donation (SNOD). These triggers aim to define a standardised point of referral and observational studies demonstrate a statistical increase in the identification of potential donors when used to screen all intensive care patients (Bair et al , 2006; Shafer et al , 2008). However, it is understood that a proportion of patients identified by these initial triggers will survive.…”

Experience With a New Process—Condition T—for Uncontrolled Donation After Circulatory Determination of Death in a University Emergency Department

“…3 However, these barriers can be overcome with appropriate attention to processes and education. 4,5 Specific solutions include speedy identification of potential donors after death, confirmation of prior voluntary authorization for organ donation, team notification and mobilization, placement of catheters for in situ organ perfusion using cold organ preservation solution, rapid preparation of operating suites, patient transport to a transplant facility, short turnaround times for tissue typing and procuring organs from potential donors, in vitro preservation, and finally implantation. Implementation of these solutions may lead to more organs transplanted and more lives saved.…”