title: Cadaveric organ donor recruitment at Los Angeles County Hospital: improvement after formation of a structured clinical, educational and administrative service.
abstract: OBJECTIVE
  There remains a critical shortage of cadaveric organs. At a large inner city level one trauma centre, several strategies were devised and combined to (a). optimize the physiologic status of potential donors, (b). promote awareness of the donation process among health care professionals and (c). perform quality control on the organ donation system - all in an effort to improve organ donation rates. Resuscitative and maintenance protocols were devised and implemented through a multidisciplinary team approach for patients diagnosed with brain death. We report the effect this approach has had on organ donation in a single centre.
  
  
  METHODS
  A death record review (DRR) by the local organ procurement agency (OPO) was used to identify the number of patients diagnosed with brain death at Los Angeles County Hospital each year from 1995 through 2001. Data were collected to determine the number of these potential donors that eventually underwent organ donation. Data were collected for two time intervals: Phase I (1995-98) and Phase II (1999-2001). During Phase I, there was no focused institutional programme for the approach to potential donors. During Phase II, an institutional programme including the following characteristics was implemented: 1). donor resuscitation protocol, 2). assignment of a dedicated OPO coordinator liaison to interact with families, hospital personnel and the coroner's office, 3). assignment of the primary role of stabilization and care of potential donors and the integration of all medical services to the trauma service, and 4). biweekly conferences to review policies, protocols, and outcomes of donor management strategies.
  
  
  RESULTS
  From 1995 to 2001 there was a large increase in patient referrals for donor evaluation from 86 (Phase I) to 124 (Phase II). There was a smaller increase in the number of suitable donors: Phase I (mean: 51/year) and Phase II (mean: 63/year). There was, however, an increase in the mean number of actual organ donors from 14.2/year to 25.7/year from Phase I to Phase II and an increase in organs donated from 29 to 49. Organ donor declines decreased from 53% (Phase I) to 39% (Phase II).
  
  
  CONCLUSIONS
  Strategies to increase the number of cadaveric organs available for organ transplantation are crucial. A strategy combining prompt identification of potential organ donors, institution of resuscitative protocols, a multidisciplinary team approach, educational activities and utilization of personnel expert in organ procurement led to a marked increase in the number of organ donors and the number of organs donated at a single institution. Wider application of this approach should prove successful in increasing organ donation in a similar fashion in other institutions.
authors.affiliation: Division of Trauma Surgery/Critical Care Medicine, University of Southern California, Los Angeles, CA 90033, USA. tkwroth@aol.com
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Roth
authors.forename: Linda
authors.initials: L
authors.lastname: Sher
authors.forename: James A
authors.initials: JA
authors.lastname: Murray
authors.forename: Howard
authors.initials: H
authors.lastname: Belzberg
authors.forename: R
authors.initials: R
authors.lastname: Mateo
authors.forename: A
authors.initials: A
authors.lastname: Heeran
authors.forename: Javier
authors.initials: J
authors.lastname: Romero
authors.forename: Tom
authors.initials: T
authors.lastname: Mone
authors.forename: Linda
authors.initials: L
authors.lastname: Chan
authors.forename: Rick
authors.initials: R
authors.lastname: Selby
mesh_terms: D002102:Cadaver; D002985:Clinical Protocols / Q000592:standards*; D006766:Hospitals, County / Q000458:organization & administration*; D006801:Humans; D015141:Los Angeles; D016377:Organ Transplantation / Q000379:methods*; D012017:Referral and Consultation / Q000458:organization & administration; D012189:Retrospective Studies; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000458:organization & administration*