Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States of America; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America.
Brandeis University, Waltham, MA, United States of America.
Transplant Rev (Orlando). 2021 Jul;35(3):100613. doi: 10.1016/j.trre.2021.100613. Epub 2021 Mar 6.
Efforts to ameliorate the organ shortage have predominantly focused on improving processes and interventions at multiple levels in the organ donation process, but no comprehensive review of hospital-level features contributing to organ donation exists. We undertook a systematic review of the literature to better understand current knowledge and knowledge gaps about hospital-level metrics and interventions associated with successful organ donation.
We searched six electronic databases (PubMed, Embase, CINAHL, Web of Science, Health Business Elite, and Google scholar) and conference abstracts for articles on hospital-level features associated with the final outcome of organ donation (PROSPERO CRD42020187080). Editorials, letters to the editor, and reviews without original data were excluded. Our main outcomes were conversion rate, donation rate, number of organs recovered, number of donors, and authorization rate.
Our search yielded 2177 studies, and after a thorough assessment, 72 articles were included in this systematic review. Studies were thematically categorized into 1) Hospital-level interventions associated with metrics of organ donation; these included patient- and family-centric measures (i.e. standardized interviews, collaborative requesting and decoupling, and dedicated in-house coordinators), and donor management goals that significantly increased conversion rates by up to 64%; 2) Hospital-level multi-stage programs/policies; which increased authorization rates between 30 and 50%; and 3) Hospital characteristics and qualities; being an academic center, trauma center and larger hospital correlated with higher authorization and conversion rates. Most studies had considerable risk of bias and were of low quality.
There is a lack of well-designed studies on hospital-level metrics and interventions associated with organ donation. The use of thoughtful, patient- and family-centric approaches to authorization generally is associated with more organ donors. Future work can build on what is known about the hospital role in organ donation to improve the entire organ donation process.
为了改善器官短缺问题，人们主要致力于在器官捐献过程的多个层面改进流程和干预措施，但目前尚缺乏关于有助于器官捐献的医院层面特征的综合综述。因此，我们系统地回顾了文献，以更好地了解当前关于与成功器官捐献相关的医院层面指标和干预措施的知识和知识空白。
我们检索了六个电子数据库（PubMed、Embase、CINAHL、Web of Science、Health Business Elite 和 Google scholar）和会议摘要，以获取与器官捐献最终结果相关的医院层面特征的文章（PROSPERO CRD42020187080）。排除社论、给编辑的信和没有原始数据的评论。我们的主要结果是转化率、捐献率、回收器官数量、捐献者数量和授权率。
我们的搜索结果为 2177 项研究，经过彻底评估，有 72 篇文章被纳入本系统综述。研究按主题分为 1）与器官捐献指标相关的医院层面干预措施；这些措施包括以患者和家庭为中心的措施（即标准化访谈、协作请求和去耦以及专门的内部协调员），以及捐赠者管理目标，这些措施将转化率提高了高达 64%；2）医院层面的多阶段计划/政策；这些计划将授权率提高了 30%至 50%；3）医院特征和质量；作为学术中心、创伤中心和较大的医院与更高的授权和转化率相关。大多数研究的偏倚风险较大，质量较低。
目前缺乏关于与器官捐献相关的医院层面指标和干预措施的精心设计的研究。一般来说，使用深思熟虑的、以患者和家庭为中心的授权方法与更多的器官捐献者相关。未来的工作可以在已知的医院在器官捐献中的作用的基础上进一步提高整个器官捐献过程。
