Organ donation: a university hospital experience.

To define the size of the donor pool among nontrauma patients and the role of physicians in the limited supply of organs available for transplantation, we reviewed the 1293 nontrauma deaths that occurred in Vanderbilt University Medical Center during a 31-month period. Computerized discharge abstracts showed that 111 adults died without contraindications to organ donation. Manual review of these 111 medical records yielded 68 records suitable for review by Tennessee Donor Services. From this group 10 eligible donors were identified. Physicians failed to ask the families of three patients, families of three patients refused organ donation, and one patient had cardiovascular collapse before the donation process could be completed. Organs were successfully donated from three patients. All eligible donors died of intracerebral hemorrhage or drug overdose. Failure of physicians to approach families for donation was not based on medical criteria, and it resulted in organ wastage. As a result of this study, we have developed a simplified audit process for hospitals to use in evaluating compliance with required request legislation.