title: Potential for deceased donation not optimally exploited:  donor action data from six countries.
abstract: BACKGROUND
  Most countries today promote living donation as an alternative to challenge the organ shortage from deceased donors. This seems justifiable provided the potential for deceased donation is optimally exploited.
  
  
  METHODS
  We used the Donor Action (DA) Medical Record Review (MRR) methodology in six countries, to measure whether the potential for heart-beating (HB) deceased donors was adequately converted to donation. Medical record review data were collected from 52,383 patients who died in 605 critical care units in 227 hospitals between January 2007 and December 2009.
  
  
  RESULTS
  On a total of 17,903 ventilated patients aged younger than 76 years and without contraindications to HB donation, 4,855 cases met criteria for brain death (BD) diagnosis and were considered potential HB donors. On average, 24.8±15.9% was not identified as potential donor, 21.9% of identified cases was not referred as such to a procurement team, and in 11.3% of identified cases, no approached was offered with the option to donate. Average consent rates/family approaches or registry consultation was 69.1±14.5%, and average conversion of potential into actual donors was 42.1±7.3%.
  
  
  CONCLUSIONS
  Over 57% of deceased potential donors in the study cohort were missed along the donation pathway because of nonidentification, no referral, no approach of relatives, or objections to donate. In countries with lower donation rates, expectedly more potential donors are missed proportionally. Efforts to increase the organ pool should therefore focus on optimizing clinical practices in deceased organ donation in addition to promoting living organ donation.
authors.affiliation: Donor Action Foundation, Prinsendreef 10, B-3210 Linden, Belgium. info@donoraction.org
authors.forename: Leo
authors.initials: L
authors.lastname: Roels
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Smits
authors.forename: Bernard
authors.initials: B
authors.lastname: Cohen
mesh_terms: D016009:Chi-Square Distribution; D046148:Donor Selection / Q000941:ethics / Q000639:trends; D005060:Europe; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D007258:Informed Consent; D007557:Israel; D016377:Organ Transplantation / Q000941:ethics / Q000639:trends; D012017:Referral and Consultation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014019:Tissue Donors / Q000941:ethics / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000941:ethics / Q000639:trends