Sonia Navarro

In-house coordinator programs improve conversion rates for organ donation.

BACKGROUND The organ supply shortage continues to be a public health care crisis, with nearly 20 people dying each day awaiting transplantation. Inability to obtain consent remains one of the major obstacles to converting potential donors into organ donors. We hypothesize that the presence of in-house coordinators (IHCs) from organ procurement organizations (OPOs) will improve organ donor conversion rates. METHODS This retrospective review analyzed the effect of an IHC program on organ donation outcome. Referrals for possible organ donation from three IHC programs to regional organ procurement organizations were included. Data regarding organ donation demographics and outcomes were compared before (Pre-IHC) and after (Post-IHC) the establishment of an IHC program. The main outcome measures were conversion and family decline rates. The conversion rate was calculated as the number of actual donors divided by the number of eligible deaths and is represented as a percentage. The IHC functioned to assess for potential donors, ensure timely referrals, provide hospital staff education, assist with family consent and donor management, and provide family support. RESULTS Post-IHC was associated with a significantly lower family decline rate (6% vs. 18%, p < 0.001), a significantly higher consent for research rate (8% vs. 0.4%, p < 0.001), and a significantly higher conversion rate (77% vs. 63%, p = 0.007) compared with Pre-IHC. In addition, a significant increase in referrals per day (0.35 vs. 0.27, p < 0.05) and organs transplanted per eligible death were noted Post-IHC. CONCLUSION The presence of an IHC program significantly improves conversion rates for organ donation as well as organ yield. An IHC program should be considered as a viable option to bridge the gap between organ supply and organ demand.

The combination of an online organ and tissue registry with a public education campaign can increase the number of organs available for transplantation.

BACKGROUND A persistent shortage of organs and inexhaustible waiting lists continue to result in many people dying while awaiting transplantation. On July 1, 2006, the California Department of Motor Vehicles joined forces with Californias Online Organ and Tissue Registry and launched a campaign to increase donation rates. This campaign included intense public and media education. The efficacy of such a campaign on donor demographics has not been studied. METHODS Retrospective analysis was conducted of organ donor referrals and donations from all southern California hospitals covered by a regional organ procurement agency. Organ donor demographics from 2 years before (pretime: 2004-2005) and 2 years after (posttime: 2007-2008) were compared. RESULTS Pretime included 6,112 referrals, 1,548 potential donors with 696 actual donors. Posttime included 7,119 referrals, 1,409 potential donors, and 699 actual donors. Consent for donation improved to 51.0% from 47.5% (p = 0.064), family decline decreased to 32.6% from 44.1% (p < 0.0001), and conversion rates improved to 49.6% from 45.0% (p = 0.011). Coroners also declined donation less frequently during posttime (1.8% vs. 0.6%, p = 0.004). Extended criteria donors improved to 9.5% from 3.8% (p < 0.0001), and donor after cardiac death improved to 3.0% from 1.4% (p = 0.002). A decrease in organs per donor was noted (3.57% vs. 3.14%, p < 0.0001) most likely because of the increase in extended criteria donors and donor after cardiac death. CONCLUSIONS Public and media education significantly improved organ donor demographics. Although this study compares only 2 years before with 2 years after the donation campaign, the results are extremely favorable. Therefore, a public donation campaign and an organ donor registry are effective promotions that could help increase the number of organs available for transplantation.

Contributing Factors for the Willingness to Donate Organs in the Hispanic American Population

OBJECTIVE To identify factors that contribute to intent to donate organs in Hispanic American individuals. DESIGN Cross-sectional telephone surveys. SETTING Four southern California neighborhoods with a high percentage of Hispanic American individuals. PATIENTS Respondents 18 years or older were drawn randomly from lists of Hispanic surnames. MAIN OUTCOME MEASURES Telephone surveys were conducted that measured demographic and socioeconomic factors, cultural factors, awareness and knowledge, and perception and belief regarding organ donation, as well as the intent to become an organ donor. Logistic regression was performed to identify independent contributing factors to intent to register for organ donation. RESULTS Five hundred twenty-four telephone surveys were conducted over a 3-week period. Seventy-three percent of those surveyed were between the ages of 18 and 44 years and the sample was equally divided between men and women. The following independent risk factors contributed to intent to register: low acculturation (adjusted odds ratio [AOR], 0.39; 95% confidence interval [CI], 0.24-0.62; P < .001), religion (AOR, 0.33; 95% CI, 0.17-0.60; P < .001), perception that the wealthy are more likely to receive organs (AOR, 0.41; 95% CI, 0.25-0.65; P = .001), belief that donation disfigures the body and impacts the funeral (AOR, 0.45; 95% CI, 0.22-0.89; P = .02), and family influence (AOR, 2.02; 95% CI, 1.28-3.22; P = .004). CONCLUSIONS Among Hispanic American individuals, low acculturation, religion, belief, and family influence affect the intent to register for organ donation. To improve organ donation, these risk factors should be considered using specific, effective educational programs.

The Impact of Race on Organ Donation Rates in Southern California

BACKGROUND The Organ Donation Breakthrough Collaborative began in 2003 to address and alleviate the shortage of organs available for transplantation. This study investigated the patterns of organ donation by race to determine if the Collaborative had an impact on donation rates among ethnic minorities. STUDY DESIGN The following data from the Southern California regional organ procurement organization were reviewed between 2004 and 2008: age, race (Caucasian, African-American, Asian, Hispanic, and other), the numbers of eligible referrals for organ donation and actual donors, types of donors, consent rates, conversion rates, organs procured per donor (OPPD), and organs transplanted per donor (OTPD). Logistic regression was used to determine independent predictors of ≥4 OTPD. RESULTS There were 1,776 actual donors out of 2,760 eligible deaths (conversion rate 64%). Hispanics demonstrated a significantly lower conversion rate than Caucasians (64% vs 77%, p < 0.001), but a considerably higher rate than African Americans (50%) and Asians (51%, p < 0.05 for both). There were no significant changes in conversion rates over time in any race. Age was a negative predictor (odds ratio [OR] 0.95), and trauma mechanism (OR 2.1) and standard criteria donor status (OR 2.5) were positive independent predictors of ≥4 OTPD. Race did not affect OTPD (all groups, p > 0.05). CONCLUSIONS Conversion rates among all ethnic minorities were significantly lower than the rates observed in Caucasians. However, when controlling for other factors, race was not a significant risk factor for the number of organs transplanted per donor. The Collaborative has not had an identifiable effect on race conversion rates during the 5 years since its implementation. Further intervention is necessary to improve the conversion rate in ethnic minorities in Southern California.

Impact of Compliance with the American College of Surgeons Trauma Center Verification Requirements on Organ Donation-Related Outcomes

BACKGROUND In order to maximize organ donation opportunities, the American College of Surgeons (ACS) requires verified trauma centers to have a relationship with an organ procurement organization (OPO), a policy for notification of the OPO, a process to review organ donation rates, and a protocol for declaring neurologic death. We hypothesized that meeting the ACS requirements will be associated with improved donation outcomes. STUDY DESIGN Twenty-four ACS-verified Level I and Level II trauma centers were surveyed for the following registry data points from 2004 to 2008: admissions, ICU admissions, patients with a head Abbreviated Injury Score ≥ 5, deaths, and organ donors. Centers were also queried for the presence of the ACS requirements as well as other process measures and characteristics. The main outcomes measure was the number of organ donors per center normalized for patient volume and injury severity. The relationship between center characteristics and outcomes was determined. RESULTS Twenty-one centers (88%) completed the survey and referred 2,626 trauma patients to the OPO during the study period, 1,008 were eligible to donate, and 699 became organ donors. Compliance with the 4 ACS requirements was not associated with increased organ donation outcomes. However, having catastrophic brain injury guidelines (CBIGs) and the presence of a trauma surgeon on a donor council were associated with significantly more organ donors per 1,000 trauma admissions (6.3 vs 4.2 and 6.0 vs 4.2, respectively, p < 0.05). CONCLUSIONS Although the ACS trauma center organ donation-related requirements were not associated with improved organ donor outcomes, involvement of trauma surgeons on donor councils and CBIGs were and should be encouraged. Additionally, incorporation of quantitative organ donation measures into the verification process should be considered.

Increasing Organ Donation in Hispanic Americans: The Role of Media and Other Community Outreach Efforts

IMPORTANCE The growing demand for organs continues to outpace supply. This gap is most pronounced in minority populations, who constitute more than 40% of the organ waiting list. Hispanic Americans are particularly less likely to donate compared with other minorities for reasons that remain poorly understood and difficult to change. OBJECTIVE To determine whether outreach interventions that target Hispanic Americans improve organ donation outcomes. DESIGN, SETTING, AND PARTICIPANTS Prospective before-after study of 4 southern California neighborhoods with a high percentage of Hispanic American residents. We conducted cross-sectional telephone surveys before and 2 years after outreach interventions. Respondents 18 years or older were drawn randomly from lists of Hispanic surnames. Awareness, perceptions, and beliefs regarding organ donation and intent to donate were measured and compared before and after interventions. INTERVENTION Television and radio commercials about organ donation and educational programs at 5 high schools and 4 Catholic churches. MAIN OUTCOMES AND MEASURES Number of survey participants who specify intent to donate. RESULTS A total of 402 preintervention and 654 postintervention individuals participated in the surveys. We observed a significant increase in awareness of and knowledge about organ donation and a significant increase in the intent to donate (17.7% vs 12.1%; adjusted odds ratio, 1.55 [95% CI, 1.06-2.26; P = .02]). CONCLUSIONS AND RELEVANCE Focused donor outreach programs sustain awareness and knowledge and can significantly improve intent to donate organs in the Hispanic American population. These programs should continue to be evaluated and implemented to influence donor registration.

Utilizing the media to help increase organ donation in the Hispanic American population

Salim A, Berry C, Ley EJ, Schulman D, Navarro S, Chan LS. Utilizing the media to help increase organ donation in the Hispanic American population. 
Clin Transplant 2011: 25: E622–E628.

A focused educational program after religious services to improve organ donation in Hispanic Americans

Religion is an important determinant in Hispanic Americans (HA) becoming organ donors as HA often believe religion forbids donation. We investigated the effect of an educational program targeting HA organ donation in places of worship. A prospective observational study was conducted at four Catholic churches with a high percentage of HA. A 45‐min “culturally sensitive” educational program, conducted in Spanish, was implemented. Organ donation awareness, knowledge, perception, and beliefs, as well as the intent to become an organ donor, were measured before and after the intervention. Differences between before and after the intervention were analyzed. A total of 182 surveys were conducted before and 159 surveys were conducted after the educational program. A significant increase was observed in organ donation knowledge (54% vs. 70%, p < 0.0001), perception (43% vs. 58%, p < 0.0001), and beliefs (50% vs. 60%, p = 0.0001). However, no significant difference was found in the willingness to discuss donation with family, intent‐to‐donate, or registering to donate after the intervention. This study demonstrates that a focused educational program in places of worship can significantly improve HA knowledge, perceptions, and beliefs regarding organ donation. Further work is needed to understand why intent‐to‐donate does not increase despite the increase in organ donation awareness.

Improving organ donor registration using kiosks in primary care clinics

Objective: In the USA, organ donor shortage is especially pronounced among minority ethnic populations such as Hispanics, who are 60% less likely to donate compared to non-Hispanic Whites. Recent evidence suggests that US Hispanics may consent to organ donation via a registry within a doctor’s office. The objective of this study was to investigate the effectiveness of using ‘kiosks’ to distribute organ donation educational material located within primary care clinics on US Hispanic donor registration rates. Design/setting: A prospective observational study was conducted at four clinics, located in Southern Californian neighbourhoods with a high percentage of Hispanics. Method: Kiosks containing organ donation educational material were set up at each clinic for a total of 7 weeks. The kiosks were unstaffed for 6 weeks, 3 weeks before and 3 weeks after a week that was staffed by individuals from OneLegacy, the local Organ Procurement Organisation (OPO). The number of patient encounters and the number of patients who registered were recorded and analysed. Registration rates per 1,000 patient encounters and 95% confidence interval (CI) were derived. Differences between the staffed and unstaffed kiosks were assessed. Results: During the 6-week unstaffed period, a total of 59,181 patient encounters occurred with a registration rate of 0.03 per 1,000 (95% CI: 0.0–0.1). During the 1-week staffed period, a total of 9,805 patient encounters occurred and 102 patients registered, which is a registration rate of 10 per 1,000 (95% CI: 8–13). Significance was reached when comparing staffed and unstaffed rates of registration (p < .0001). Conclusion: This study demonstrates that when compared with unstaffed kiosks, staffed kiosks are more effective in increasing organ donation registration among US Hispanics.