Valikodath Nishma, Lambert A Nicole, Butler Alison, Lebovitz Daniel J, Chapman Gretchen, Xu Meng, Slaughter James C, Menachem Jonathan N, Godown Justin
Department of Pediatrics, Children's Hospital at Vanderbilt. Nashville, Tennessee.
Pediatric Cardiology, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky.
J Heart Lung Transplant. 2023 May;42(5):627-636. doi: 10.1016/j.healun.2022.12.023. Epub 2023 Jan 6.
Lack of donor organ availability represents a major limitation to the success of solid organ transplantation. The Scientific Registry of Transplant Recipients (SRTR) publishes performance reports of organ procurement organizations (OPO) in the United States, but does not stratify by the mechanism of donor consent, namely first-person authorization (organ donor registry) and next-of-kin authorization. This study aimed to report the trends in deceased organ donation in the United States and assess the regional differences in OPO performance after accounting for the different mechanisms of donor consent.
The SRTR database was queried for all eligible deaths (2008-2019) which were then stratified based on the mechanism of donor authorization. Multivariable logistic regression was performed to assess the probability of organ donation across OPOs based on specific donor consent mechanisms. Eligible deaths were divided into 3 cohorts based on the probability to donate. Consent rates at the OPO level were calculated for each cohort.
Organ donor registration among adult eligible deaths in the U.S. increased over time (2008: 10% vs 2019: 39%, p < 0.001), coincident with a decline in next-of-kin authorization rates (2008: 70% vs 2019: 64%, p < 0.001). At the OPO level, the increased organ donor registration was associated with lower next-of-kin authorization rates. Among eligible deaths with medium- and low-probability of donation, recruitment was highly variable across OPO's, ranging from 36% to 75% in the medium-probability group (median 54%, IQR 50%-59%) and 8% and 73% in the low-probability group (median 30%, IQR 17%-38%).
Significant variability exists across OPOs in the consent of potentially persuadable donors after adjusting for population demographic differences and the mechanism of consent. Current metrics may not truly reflect OPO performance as they do not account for consent mechanism. There is further opportunity for improvement in deceased organ donation through targeted initiatives across OPOs, modeled after regions with the best performance.
供体器官的可获得性不足是实体器官移植成功的主要限制因素。移植受者科学注册系统（SRTR）公布了美国器官获取组织（OPO）的绩效报告，但未按供体同意机制进行分层，即第一人称授权（器官捐赠登记）和近亲授权。本研究旨在报告美国已故器官捐赠的趋势，并在考虑不同供体同意机制后评估OPO绩效的地区差异。
查询SRTR数据库中所有符合条件的死亡病例（2008 - 2019年），然后根据授权机制进行分层。进行多变量逻辑回归，以评估基于特定供体同意机制的各OPO进行器官捐赠的概率。根据捐赠概率将符合条件的死亡病例分为3组。计算每组在OPO层面的同意率。
美国成年符合条件死亡病例中的器官捐赠登记随时间增加（2008年：10% vs 2019年：39%，p < 0.001），同时近亲授权率下降（2008年：70% vs 2019年：64%，p < 0.001）。在OPO层面，器官捐赠登记的增加与较低的近亲授权率相关。在捐赠概率为中低的符合条件死亡病例中，各OPO的招募情况差异很大，中概率组为36%至75%（中位数54%，四分位间距50% - 59%）；低概率组为8%至73%（中位数30%，四分位间距17% - 38%）。
在调整人口统计学差异和同意机制后，各OPO在说服潜在捐赠者同意方面存在显著差异。当前指标可能无法真正反映OPO的绩效，因为它们未考虑同意机制。通过以表现最佳地区为蓝本，在各OPO开展有针对性的举措，已故器官捐赠仍有进一步改善的空间。
