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Gaps in organ donation consent rates result in thousands of unrealized transplants

Between 2008 and 2013, organ donation consent rates varied widely, from approximately 64% to 90%, across the country, according to recently published data in the American Journal of Transplantation.

“These data demonstrate that although the underlying demographic of the donor population may contribute to geographic differences in organ consent rates, it clearly is not the major driving factor. Although there may be underlying cultural or religious differences leading to variable consent rates, the dramatic differences in consent rates among younger Caucasians clearly show that race alone cannot explain geographical differences in organ donor consent rates,” study researcher David Goldberg, MD, MSCE, division of gastroenterology at the University of Pennsylvania, said in a press release. 

To assess the variation of organ donation consent across service areas and to measure the potential gains from increased authorization rates, researchers performed a retrospective cohort study of 52,571 “eligible deaths” between 2008 and 2013 using data from the Organ Procurement and Transplantation Network (OPTN).

Results demonstrated that between 2008 and 2013, overall organ donation consent was obtained in 73.1% of cases. However, significant variation (P < .001) in authorization rates were seen across the 58 designated service areas, ranging from 63.5% to 89.5%. Among donors, family or next-of-kin authorizations provided consent in 80.3% of donations, and 19.7% of donations were made through donor registries.  

A significant positive correlation was seen between a donor service area’s overall unadjusted authorization rate and authorization rates of donors aged 18 to 39 years, which is considered the ideal donation age range.

Authorization rates were also significantly associated with donor age, race, cause of death, timely referrals, weekday referrals and rural urban commuting areas of donor hospitals. However, substantial disparities in donor authorization rates were seen across all designated service areas, even after adjusting for age, race and cause of death and geographic factors such as rural/urban status of hospitals and a state’s inclusion in deceased-donor registries.

The researchers noted that if all designated service areas had a 72.7% authorization rate during the study period, there would have been a potential increase of between 2,679 and 5,710 available organs.

Improving the rates of organ donor authorization rates is possible, according to the researchers, by building better associations with organ procurement operations, the Health Resources and Services Administration, OPTN and CMS.

“With over 10,000 patients a year dying on a transplant waiting list or becoming too sick to undergo a transplant, these data highlight the potential opportunity to save hundreds of more lives each year by increasing consent rates among potential organ donors. By increasing organ donation consent rates, and optimizing how we utilize a scarce resource, the transplant community can help OPTN achieve its highest priority of increasing the number of transplants each year in the U.S.,” study researcher Richard Gilroy, MD, medical director of liver transplantation at the University of Kansas Hospital, said in a press release. – by Casey Hower