Organ donation after death in Ontario: a population-based cohort study

Abstract

Background: Shortfalls in deceased organ donation lead to shortages of solid organs available for transplantation. We assessed rates of deceased organ donation and compared hospitals that had clinical services for transplant recipients (transplant hospitals) to those that did not (general hospitals).

Methods: We conducted a population-based cohort analysis involving patients who died from traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage or other catastrophic neurologic conditions in Ontario, Canada, between Apr. 1, 1994, and Mar. 31, 2011. We distinguished between acute care hospitals with and without transplant services. The primary outcome was actual organ donation determined through the physician database for organ procurement procedures.

Results: Overall, 87,129 patients died from catastrophic neurologic conditions during the study period, of whom 1930 became actual donors. Our primary analysis excluded patients from small hospitals, reducing the total to 79,746 patients, of whom 1898 became actual donors. Patients who died in transplant hospitals had a distribution of demographic characteristics similar to that of patients who died in other large general hospitals. Transplant hospitals had an actual donor rate per 100 deaths that was about 4 times the donor rate at large general hospitals (5.0 v. 1.4, p < 0.001). The relative reduction in donations at general hospitals was accentuated among older patients, persisted among patients who were the most eligible candidates and amounted to about 121 fewer actual donors per year (adjusted odds ratio 0.58, 95% confidence interval 0.36-0.92). Hospital volumes were only weakly correlated with actual organ donation rates.

Interpretation: Optimizing organ donation requires greater attention to large general hospitals. These hospitals account for most of the potential donors and missed opportunities for deceased organ donation.

Figure 1:

(A) Number of deceased donors and (B) number deaths from catastrophic neurologic conditions during the study period. An anomaly in the numbers of catastrophic neurologic deaths between 2001 and 2002 denotes a change from International Classification of Diseases (ICD), 9th revision, to the ICD 10th revision. An increase in donors over time with a persistent gap between the number of patients who died from catastrophic neurologic conditions and those who became donors can be seen.

Figure 2:

Rates of organ donation, by hospital, among patients who died from catastrophic neurologic conditions and the overall rate of deceased organ donation, showing a modest correlation of total deaths with overall donation rates (r = 0.61, p < 0.001).

Figure 3:

Organ donation by geographic area in Ontario. The 14 areas represent official Local Health Integration Networks. Note: HSC = Hospital for Sick Children, Toronto; KGH = Kingston General Hospital, Kingston; LHSC = London Health Sciences Centre, London; TOH = The Ottawa Hospital, Ottawa; SJH = St. Joseph’s Healthcare, Hamilton; SMH = St. Michael’s Hospital, Toronto; UHN = University Health Network, Toronto.