(115) More Organs for Transplant: An Improvement Strategy to Increase Organ Donation Authorization Rates

Introduction: Improving donation authorization remains critical to increasing the availability of organs for life-saving transplants. Asking families for the time it takes for organ donation to unfold after they have decided to withdraw support or received a final brain death diagnosis has been identified as a major factor in decisions to decline donation. Our organ procurement organization (OPO) hypothesized that presenting the donation option to families sooner, prior to end of life decisions rather than afterwards, would decrease declines due to timing and increase authorization rates for organ donation.

Methods: We developed a strategy to evaluate the impact of timing on authorization rates by implementing donation discussions with families prior to brain death declaration or end of life decisions. We measured the effectiveness of the preliminary discussion on the subsequent authorization outcomes (whether a family authorized or declined donation) and compared to cases where a preliminary discussion was not implemented. Further, we tracked the percentage of times our OPO implemented a preliminary discussion compared to the total number of organ donation discussions conducted during the timeframe.

Results: From January 1, 2021 to June 30, 2023, our OPO conducted 2560 organ donation discussions with potential donor families. Of these, 15.7% (403 conversations) included a preliminary discussion for organ donation and 72% authorized donation which was 12% higher than cases with no preliminary discussion. The OPO further deployed this strategy in January 1, 2023 to June 30, 2023, and implemented a preliminary discussion in 33% of all donation discussions (versus 11% in the prior two years) with similar improvements in authorization (13% higher in the preliminary discussion group). Further evidence of success with the preliminary discussion strategy is a 9% reduction of declines due to timing.

Conclusions: Addressing barriers to donation authorization is paramount to increasing organ transplants. By implementing a preliminary discussion about organ donation, we reduced donation declines due to timing. Preliminary discussions for donation are successful because it sets process expectations early and allows the donor’s family the opportunity to weave the timing for organ donation into their end of life plan.