Increasing organ recovery from level I trauma centers: the in-house coordinator intervention

Progress in Transplantation, Sep 2004 by Shafer, Teresa J, Ehrle, Ronald N, Davis, Kimberly D, Durand, Roger E, Et al

Purpose-Daily presence of organ procurement organization staff in level I trauma centers combined with early family contact and interaction can increase donation rates.

Methods-A successful in-house coordinator program already in place at 2 level I trauma centers in Houston was replicated in 6 other level I trauma centers in New York City, Los Angeles, and Seattle. Organ procurement organization staff were placed inside the 8 trauma centers to provide early family support in potential donor situations and day-to-day donation system management. Comparison data were obtained on 83 level I trauma centers nationally. Data from 1999 to 2000 were compared with data from 2001 to 2002.

Results-Despite demographic differences, the 8 centers with in-house coordinators had higher consent rates (60% vs 53%) and conversion rates (55% vs 45%) than centers without them. Conversion of potential to actual donors was 22% higher in centers with in-house coordinators than in centers without them. Donation rates were affected by donor age, ethnicity, previous family discussion of donation, the family's initial reaction to the request (favorable, unfavorable, undecided), amount of time family spent with the in-house coordinator, presence of the in-house coordinator during explanation of brain death, whether the request was made at the same lime as the brain-death explanation, and, in cases where donation was mentioned to the family before the formal request, who first mentioned donation to the family.

Conclusions-In-house coordinators improve the donation process by interacting with families and staff earlier and more often during potential organ donations and improving donation systems through closer relationships with hospital staff. (Progress in Transplantation. 2004; 14:250-263)

Increased rates of organ donation have not kept up with demand despite the growing attention given to the organ shortage by Congress; the Department for Health and Human Services; voluntary health associations such as the American Hospital Association, American Medical Association, and Joint Commission for Accreditation on Hospitals; and numerous professional societies as well as the general public. Shafer et al1 noted that although the number of hospitals that had organ donors increased, particularly the number of hospitals with 6 to 44 organ donors, the national conversion rate of potential donors to actual donors in 2000 was only 42%.2 Level I trauma centers (LITCs) had a marginally higher rate of 45% in 2000.1

In 1993, Klassen et aP concluded that most large public trauma hospitals have not been successful at converting large numbers of potential donors to actual donors, even though hospitals with LITCs were 5 times more likely to be donor hospitals than other hospitals. She found that of the 232 LITCs in the United States in 1992, 13% (30 hospitals) produced no organ donors and 37% produced only between 1 and 5 organ donors. Because of the nature of their patients' demographics, the nation's large trauma facilities have significant numbers of potential organ donors and a greater potential to produce organ donors than do acute care hospitals.

In 1996, an organ procurement organization (OPO) in Houston, Tex, developed and implemented an intervention that led to a 55% increase in the number of organ donors at the 2 LITCs in Houston.1 These facilities served large minority populations. The OPO placed trained and qualified full-time in-house coordinators (IHCs) in these LITCs. The IHCs, who were nurses, were trained as organ procurement coordinators by the OPO and were assigned solely to work within the 2 LITCs. Their duties included all those activities that are normally performed in the course of providing service to a donor hospital, with the additional requirement that they staff and maintain an office in the LITC. The IHCs were integrated into the hospital team, allowing them to begin establishing relationships with families earlier in the hospitalization than had been possible before the implementation of the IHC program.

Based on the success achieved in Houston, the OPO proposed to study the effectiveness of this intervention at LITCs in 3 other major metropolitan areas in the country to determine its effectiveness in other LITCs and, if successful, to package the intervention for replication as a model program. In 1999, the OPO was awarded a 3-year Phase Two Project for the Extramural Support Program's Model Interventions to Increase Organ and Tissue Donation, from the Division of Transplantation of the Health Resources Services Administration, Department of Health and Human Services, to implement this study, which was called the Project to Increase Organ Recovery From Level I Trauma Centers. The project period started September 30, 1999 and concluded September 29, 2002.

Objective

The objective was to evaluate whether placement of OPO staff (IHCs) in LITCs with large donor potential, to provide case management as well as donation system development, would result in a significant increase in organ donation, particularly among members of minority groups.