Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 144 No. 4344 (2014)

Swiss Monitoring of Potential Organ Donors (SwissPOD): a prospective 12-month cohort study of all adult ICU deaths in Switzerland

  • Julius H. Weiss
  • Isabelle Keel
  • Franz F. Immer
  • Jan Wiegand
  • Christoph Haberthür
  • Comité National du Don d’Organes (CNDO)
DOI
https://doi.org/10.4414/smw.2014.14045
Cite this as:
Swiss Med Wkly. 2014;144:w14045
Published
19.10.2014

Abstract

BACKGROUND: The Swiss Monitoring of Potential Organ Donors (SwissPOD) was initiated to investigate the causes of the overall low organ donation rate in Switzerland. The objective of our study was an assessment of the donation after brain death (DBD) process in Swiss adult intensive care units (ICUs), and to provide an overview of the donation efficiency as well as of the reasons for non-donation.

METHODS: SwissPOD is a prospective cohort study of all deaths in Swiss ICUs and accident and emergency departments. This study is an analysis of SwissPOD data of all patients who deceased in an adult ICU between 1 September 2011 and 31 August 2012.

RESULTS: Out of 3,667 patients who died in one of the 79 adult ICUs participating in SwissPOD, 1,204 were possible, 198 potential, 133 eligible, and 94 utilised DBD donors. The consent rate was 48.0% and the conversion rate 47.5%. In 80.0% of cases, the requests for donation took place before brain death was diagnosed, resulting in a similar proportion of consents and objections as when requests were made after brain death diagnosis.

CONCLUSIONS: Despite the low donation rate, Swiss adult ICUs are performing well in terms of the conversion rate, similar to major European countries. The refusal rate is among the highest in Europe, which clearly has a negative impact on the donation rate. Optimising the request process seems to be the most effective means of increasing the donation rate.

References

  1. The International Registry in Organ Donation and Transplantation (IRODaT). Preliminary 2012 Data. 2013.
  2. Swisstransplant. Jahresbericht 2011. The Swiss National Foundation for organ donation and transplantation; Bern, 2012 [Annual Report; cited 2013 Dec 4]. Available from: http://www.swisstransplant.org/
  3. Abouna GM. Organ shortage crisis: problems and possible solutions. Transplant Proc. 2008;40:34–8.
  4. Cuende N, Cuende JI, Fajardo J, Huet J, Alonso M. Effect of population aging on the international organ donation rates and the effectiveness of the donation process. Am J Transplant. 2007;7:1526–35.
  5. Barber K, Falvey S, Hamilton C, Collett D, Rudge C. Potential for organ donation in the United Kingdom: audit of intensive care records. BMJ. 2006;332:1124–7.
  6. Sheehy E, O’Connor KJ, Luskin RS, Howard RJ, Cornell D, Finn J, et al. Investigating geographic variation in mortality in the context of organ donation. Am J Transplant. 2012;12:1598–602.
  7. Coppen R, Friele RD, Gevers SKM, Blok GA, van der Zee J. The impact of donor policies in Europe: a steady increase, but not everywhere. BMC Health Serv Res. 2008;8:235.
  8. Friele RD, Coppen R, Marquet RL, Gevers JKM. Explaining differences between hospitals in number of organ donors. Am J Transplant. 2006;6:539–43.
  9. Mossialos E, Costa-Font J, Rudisill C. Does organ donation legislation affect individuals’ willingness to donate their own or their relative’s organs? Evidence from European Union survey data. BMC Health Serv Res. 2008;8:48.
  10. Rithalia A, McDaid C, Suekarran S, Myers L, Sowden A. Impact of presumed consent for organ donation on donation rates: a systematic review. BMJ. 2009;338:a3162.
  11. Irving MJ, Tong A, Jan S, Cass A, Rose J, Chadban S, et al. Factors that influence the decision to be an organ donor: a systematic review of the qualitative literature. Nephrol Dial Transplant. 2012;27:2526–33.
  12. Salim A, Malinoski D, Schulman D, Desai C, Navarro S, Ley EJ. The combination of an online organ and tissue registry with a public education campaign can increase the number of organs available for transplantation. J Trauma. 2010;69:451–4.
  13. Paez G, Valero R, Manyalich M. Training of health care students and professionals: a pivotal element in the process of optimal organ donation awareness and professionalization. Transplant Proc. 2009;41:2025–9.
  14. Pelleriaux B, Roels L, Van Deynse D, Smits J, Cornu O, Delloye C. An analysis of critical care staff’s attitudes to donation in a country with presumed-consent legislation. Prog Transplant. 2008;18:173–8.
  15. DuBois JM, Anderson EE. Attitudes toward death criteria and organ donation among healthcare personnel and the general public. Prog Transplant. 2006;16:65–73.
  16. Georgiadou E, Sounidakis N, Mouloudi E, Giaglis P, Giasnetsova T, Marmanidou K, et al. Attitudes and behavior toward organ donation in Greece. Transplant Proc. 2012;44:2698–2701.
  17. Ormrod JA, Ryder T, Chadwick RJ, Bonner SM. Experiences of families when a relative is diagnosed brain stem dead: understanding of death, observation of brain stem death testing and attitudes to organ donation. Anaesthesia. 2005;60:1002–8.
  18. Bøgh L, Madsen M. Attitudes, knowledge, and proficiency in relation to organ donation: a questionnaire-based analysis in donor hospitals in northern Denmark. Transplant Proc. 2005;37:3256–7.
  19. Morgan SE, Miller JK. Beyond the organ donor card: the effect of knowledge, attitudes, and values on willingness to communicate about organ donation to family members. Health Commun. 2002;14:121–34.
  20. Scandroglio B, Domínguez-Gil B, López JS, Valentín MO, Martín MJ, Coll E, et al. Analysis of the attitudes and motivations of the Spanish population towards organ donation after death. Transpl Int. 2011;24:158–66.
  21. Siminoff LA, Burant C, Youngner SJ. Death and organ procurement: public beliefs and attitudes. Kennedy Inst Ethic J. 2004;14:217–34.
  22. Roels L, Smits J, Cohen B. Potential for deceased donation not optimally exploited: Donor Action data from six countries. Transplantation. 2012;94:1167–71.
  23. Wesslau C, Grosse K, Krüger R, Kücük O, Mauer D, Nitschke FP, et al. How large is the organ donor potential in Germany? Results of an analysis of data collected on deceased with primary and secondary brain damage in intensive care unit from 2002 to 2005. Transpl Int. 2007;20:147–55.
  24. Organ Procurement Working Group. Audit of potential organ donors Republic of Ireland. Health Service Executive; 2009 [cited 2013 Dec 4]. Available from: http://www.lenus.ie/hse/handle/10147/85814
  25. Madsen M, Bøgh L. Estimating the organ donor potential in Denmark: a prospective analysis of deaths in intensive care units in northern Denmark. Transplant Proc. 2005;37:3258–9.
  26. Jansen NE, van Leiden HA, Haase-Kromwijk BJJM, Hoitsma AJ. Organ donation performance in the Netherlands 2005–08; medical record review in 64 hospitals. Nephrol Dial Transplant. 2010;25:1992–7.
  27. Sheehy E, Conrad SL, Brigham LE, Luskin R, Weber P, Eakin M, et al. Estimating the number of potential organ donors in the United States. N Engl J Med. 2003;349:667–74.
  28. Garside J, Garside M, Fletcher S, Finlayson B. Utilisation of an embedded specialist nurse and collaborative care pathway increases potential organ donor referrals in the emergency department. Emerg Med J. 2012;29:228–32.
  29. Matesanz R, Domínguez-Gil B, Coll E, de la Rosa G, Marazuela R. Spanish experience as a leading country: what kind of measures were taken? Transpl Int. 2011;24:333–43.
  30. Matesanz R, Marazuela R, Domínguez-Gil B, Coll E, Mahillo B, de la Rosa G. The 40 donors per million population plan: an action plan for improvement of organ donation and transplantation in Spain. Transplant Proc. 2009;41:3453–6.
  31. Matesanz R, Miranda B. A decade of continuous improvement in cadaveric organ donation: the Spanish model. J Nephrol. 2002;15:22–8.
  32. Roels L, Wight C. Donor Action: an international initiative to alleviate organ shortage. Prog Transplant. 2001;11:90–7.
  33. Wynn JJ, Alexander CE. Increasing organ donation and transplantation: the U.S. experience over the past decade. Transpl Int. 2011;24:324–32.
  34. Howard DH, Siminoff LA, McBride V, Lin M. Does quality improvement work? Evaluation of the Organ Donation Breakthrough Collaborative. Health Serv Res. 2007;42:2160–73.
  35. Shafer TJ, Wagner D, Chessare J, Schall MW, McBride V, Zampiello FA, et al. US organ donation breakthrough collaborative increases organ donation. Crit Care Nurs Q. 2008;31:190–210.
  36. Griffiths J, Verble M, Falvey S, Bell S, Logan L, Morgan K, et al. Culture change initiatives in the procurement of organs in the United kingdom. Transplant Proc. 2009;41:1459–62.
  37. Kong AP, Barrios C, Salim A, Willis L, Cinat ME, Dolich MO, et al. A multidisciplinary organ donor council and performance improvement initiative can improve donation outcomes. Am Surg. 2010;76:1059–62.
  38. Domínguez-Gil B, Delmonico FL, Shaheen FAM, Matesanz R, O’Connor K, Minina M, et al. The critical pathway for deceased donation: reportable uniformity in the approach to deceased donation. Transpl Int. 2011;24:373–8.
  39. SR 810.211. Verordnung über die Transplantation von menschlichen Organen, Geweben und Zellen (Transplantationsverordnung) vom 16. März 2007 (Stand am 1. Januar 2013) [Transplantation Ordinance; cited 2013 Dec 4]. Available from: http://www.admin.ch/opc/de/classified-compilation/20051806/201301010000/810.211.pdf
  40. de la Rosa G, Domínguez-Gil B, Matesanz R, Ramón S, Alonso-Álvarez J, Araiz J, et al. Continuously evaluating performance in deceased donation: the Spanish quality assurance program. Am J Transplant. 2012;12:2507–13.
  41. Simpkin AL, Robertson LC, Barber VS, Young JD. Modifiable factors influencing relatives’ decision to offer organ donation: systematic review. BMJ. 2009;338(b991):online first doi:10.1136/bmj.b991.
  42. Rodrigue JR, Cornell DL, Howard RJ. Organ donation decision: comparison of donor and nondonor families. Am J Transplant. 2006;6:190–8.
  43. English V. Is presumed consent the answer to organ shortages? Yes. BMJ. 2007;334:1088.
  44. Wright L. Is presumed consent the answer to organ shortages? No. BMJ. 2007;334:1089.
  45. Abadie A, Gay S. The impact of presumed consent legislation on cadaveric organ donation: a cross-country study. J Health Econ. 2006;25:599–620.
  46. Roels L, Rahmel A. The European experience. Transpl Int. 2011;24:350–67.
  47. Quigley M, Brazier M, Chadwick R, Michel MN, Paredes D. The organs crisis and the Spanish model: theoretical versus pragmatic considerations. J Med Ethics. 2008;34:223–4.
  48. Directorate General Health and Consumer Protection (SANCO). Special Eurobarometer 272 "Europeans and organ donation". European Commission; 2007 [cited 2013 Dec 4]. Available from: http://ec.europa.eu/public_opinion/archives/ebs/ebs_272d_en.pdf
  49. Lock M, Crowley-Makota M. Situating the practice of organ donation in familial, cultural, and political context. Transplant Rev. 2008;22:154–7.
  50. Siminoff LA, Gordon N, Hewlett J, Arnold RM. Factors influencing families’ consent for donation of solid organs for transplantation. JAMA. 2001;286:71–7.
  51. Siminoff LA, Burant CJ, Ibrahim SA. Racial disparities in preferences and perceptions regarding organ donation. J Gen Intern Med. 2006;21:995–1000.
  52. Schulz PJ, Nakamoto K, Brinberg D, Haes J. More than nation and knowledge: cultural micro-diversity and organ donation in Switzerland. Patient Educ Couns. 2006;64:294–302.
  53. Vincent A, Logan L. Consent for organ donation. Br J Anaesth. 2012;108:i80–7.
  54. Exley M, White N, Martin JH. Why families say no to organ donation. Crit Care Nurse. 2002;22:44–51.
  55. Council of Europe. International figures on donation and transplantation 2011. Newsletter Transplant. 2012;17.
  56. Murphy C, Allen J. Potential donor audit annual report, 1 April 2011 to 31 March 2012. NHS Blood and Transplant; 2012 [cited 2013 Dec 4]. Available from: http://www.organdonation.nhs.uk/statistics/potential_donor_audit/pdf/pda_report_1112.pdf
  57. Jansen NE, Haase-Kromwijk BJJM, van Leiden HA, Weimar W, Hoitsma AJ. A plea for uniform European definitions for organ donor potential and family refusal rates. Transpl Int. 2009;22:1064–72.
  58. Weiss J, Hofmann SP, Immer FF. Patient characteristics of deceased organ donors in Switzerland 1998–2008. Swiss Med Wkly. 2011;141:w13265.
  59. Meers C, Van Raemdonck D, Van Gelder F, Van Hees D, Desschans B, De Roey J, et al. Change in donor profile influenced the percentage of organs transplanted from multiple organ donors. Transplant Proc. 2009;41:572–5.
  60. Messersmith EE, Arrington C, Alexander C, Orlowski JP, Wolfe R. Development of donor yield models. Am J Transplant. 2011;11:2075–84.
  61. Bendorf A, Kerridge IH, Kelly PJ, Pussell B, Guasch X. Explaining failure through success: a critical analysis of reduction in road and stroke deaths as an explanation for Australia’s low deceased organ donation rates. Internal Med. 2012;42:866–73.
  62. European Commission. Mortality rates for ICD 10 I60–69 and V01–99 (2010 data, © European Union, 1995–2012). European Commission / Eurostat; 2013 [cited 2013 Dec 4]. Available from: http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home.
  63. The International Registry in Organ Donation and Transplantation (IRODaT). Second report data. 2012.