title: Organ donor potential and performance: size and nature of the organ donor shortfall.
abstract: OBJECTIVE
  To estimate the potential for solid organ donation; to identify modifiable reasons for nondonation.
  
  
  METHODS
  Retrospective medical records review.
  
  
  METHODS
  Sixty-nine acute care hospitals in four geographic areas of the United States in 1990, and a stratified random sample of 89 hospitals in three of the same areas and 33 of the same hospitals in 1993.
  
  
  METHODS
  PATIENTS < or = 70 yrs of age who were brain dead and medically suitable for donation.
  
  
  METHODS
  None.
  
  
  RESULTS
  Standard forms were used to record patient demographic and hospital information. Reasons for nondonation were coded as "not identified," "family not asked," "consent denied," or "other." The main outcome measures were rate of donation and rates of nonidentification, not asking, and nonconsent. Organ donation occurred among 33% (299/916) of medically suitable cases identified in 1990 (95% confidence interval 30% to 36%). Ninety-four potential donors were not identified, 156 were not asked, 326 families denied consent, and 41 potential donors were categorized as "other," including patients who had suffered a cardiac arrest, and medical examiner prohibition of donation. In the 1993 study, organ donation occurred in an estimated 33% of suitable cases. In 1990, rates of donation were highest among patients <50 yrs of age, patients who died of traumatic causes, and non-Hispanic white patients. Logistic regression showed lower odds of donation for African American patients (odds ratio 0.38, 95% confidence interval 0.23 to 0.63) independent of potentially confounding hospital and patient variables (p=.0001). Donation rates did not vary by hospital size or type.
  
  
  CONCLUSIONS
  Despite legal and policy initiatives, only one third of potential donors became donors in 1990, with similar results in 1993. Extrapolating the 1990 findings to the United States suggests a pool of 13,700 medically suitable donors per year. Prospective identification and requesting donation in all suitable potential donor cases could lead to 1,800 additional donors per year.
authors.affiliation: Department of Health and Social Behavior, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Gortmaker
authors.forename: C L
authors.initials: CL
authors.lastname: Beasley
authors.forename: L E
authors.initials: LE
authors.lastname: Brigham
authors.forename: H G
authors.initials: HG
authors.lastname: Franz
authors.forename: R N
authors.initials: RN
authors.lastname: Garrison
authors.forename: B A
authors.initials: BA
authors.lastname: Lucas
authors.forename: R H
authors.initials: RH
authors.lastname: Patterson
authors.forename: A M
authors.initials: AM
authors.lastname: Sobol
authors.forename: N A
authors.initials: NA
authors.lastname: Grenvik
authors.forename: M J
authors.initials: MJ
authors.lastname: Evanisko
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D005260:Female; D006742:Hospital Bed Capacity; D006753:Hospital Records; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data / Q000600:supply & distribution; D009927:Tissue and Organ Procurement; D014481:United States