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Maximising the Donor Pool
The critical shortage of donor organs
remains the single greatest impediment facing transplant programmes around the world.
Live donation, both related and unrelated, is a real option. In Normay, 40 per cent of transplants are live donor transplants, in the US the figure is 27 per cent with the rest of Europe and the world somewhere behind. Terasaki's paper in the New Fog/and Jouo7a/ of Medicine (10 August 1995) confirmed the success of the procedure, and data from Norway and other countries has shown minimal morbidity for donors. Using sub-optimal donors is also heing widely investigated, particularly non-heart heating donors and donors over the age of 55. With appropriate care, good results have been reported with organs from elderly donors from centres in Spain, for example. In a retrospective study of 430 recipients in a single centre in Madrid, the authors concluded that kidneys from older patients had a morse outcome, hut that the patient survival for recipients is not adversely affected and that older donors should be considered. Professor Joseph Lioveras (Barcelona) added that, in his experience, particular attention should he paid to reduce the negative impact of some manageable factors that may induce mechanisms of inflammation and repair, that may lead to endothelial and interstitial damage with conseguent reduction of the nephron mass. Currently, 22 per cent of donors are older than 60 and 55 per cent older than 45 years in his centre.
" The critical shortage of donor organs remains the single greatest impediment facing transplant programmes "
Educating both the general public and the medical profession has always been critical in creating a successful transplantation programme. Donor Action, supported by Novartis, is an initiative aimed at all those involved in the organ donation process (Figure 1). Donor Action helps hospitals to gather baseline data on donor potential, identity problem areas in the donation process and create strategies to improve donation practices. It is an international initiative born out of a joint collaboration between The Eurotranspiant Foundation qhe Netherlands), Organizacion Nacional de Jrasplantes (Spain) and The Partnership for Organ Donation (USA).
Pilot evaluations are underway in 11 hospitals in the Netherlands, Spain, the UK and Canada. Data from the first stage pilots show significant potential for improvement in donation rates. Aggregated medical record review results, based on 579 patients who had died in intensive care units, showed no obvious contraindication to donation in 68 per cent of cases. However, only 31 per cent of these potential donors became actual donors. In all pilots, problems were mostly seen in donor identification and/or management (42 per cent) and family or coroner refusals (26 per cent).
Aggregated data from hospital attitude surveys of 2129 critical care medical and nursing staff reveal consistently strong support for organ donation, but many do not feel comfortable when performing key tasks close to donation. Belief that organ donation saves lives (97 per cent), support for donation (94 per cent) and willingness to donate their own organs (79 per cent) are high in all country samples. However, significant differences exist among countries, hospitals and individual ICUs in self reported skills in donation related tasks.
Donor Action aims to help improve the donor situation through better donation practices, by providing hospitals with guidelines, tools and resources. Although only implemented in pilot hospitals to date, the initiative has so far proved fo be a good motivating tool for the transplant and donor care teams, with an associated increase in the number of donors.