Hospital Boosts Transplant Donations By Integrating Bereavement, Donor Services

A UK hospital that combined its bereavement and donation services saw a forty-fold increase in tissue donations, such as corneas, in just five years, according to research in the August issue of Anaesthesia.

"We decided to address the problem of low organ and tissue donation rates by amalgamating the two services and introducing a trigger to automatically refer all potential organ donors to the regional transplant donor co-ordinators" explains Bereavement and Donor Co-ordinator Fiona Murphy from the Royal Bolton Hospital, UK.

"Between 2002 and 2007 the number of tissue donors rose from six to 246, while solid organ donation rates remained stable. The introduction of the automatic trigger in 2007 resulted in 31 referrals and 11 multi-organ donors.

"Our current service exceeds the aims of the 2008 Organ Donation Taskforce and offers us the potential to meet our organ donation targets without resorting to an 'opt out' system of presumed consent."

The gap between supply and demand of transplant organs in the developed world has led to a variety of initiatives to improve donation rates.

The UK has one of the lowest rates of organ donations in Western Europe and the number of donors has fallen by around 20 per cent over the last 10 years, while demand for transplants has grown.

"Two factors are known to mitigate against successfully increasing donor rates" says Fiona. "The first reason is the failure of staff to identify and refer potential donors. The second is the decrease in the number of brain stem dead patients – this is due to fewer catastrophic head injured patients being admitted to intensive care units because of medical advances and improved road safety.

"In mainland Europe and the USA, these problems have been addressed by introducing automatic referral of potential donors, initiating Non-Heart Beating Donation (NHBD) programmes and by legislation imposing presumed consent. NHBD is the retrieval of organs from patients who have suffered a heart attack and the blood supply to their brain has been cut off for sufficient time for brain death to have occurred. Before the 1970s all kidneys from deceased donors were retrieved using this criteria."

The Bolton initiative, which is run by a full-time Bereavement and Donor Co-ordinator supported by a critical care consultant, provides hospital staff with round-the-clock access to a Bereavement and Donation Officer.

"The aim of the service is to integrate donations as a normal part of end-of-life care and provide the same high level of care for patients and their families regardless of whether or not they donate" explains Fiona.

From 2002 to 2005 the service consisted of one fully funded nurse working with a critical care consultant. In 2005 a further four staff were employed part time to form part of a local corneal retrieval service and the 24-hour on-call service was established. A year later the organ donation and bereavement service was combined.

"The success of our integrated bereavement and donation service suggests that the Taskforce was right to promote donor identification and normalise donations in end-of-life care as a solution to the organ donor crisis."

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