title: An international comparison of the effect of policy shifts to organ donation following cardiocirculatory death (DCD) on donation rates after brain death (DBD) and transplantation rates.
abstract: During the past decade an increasing number of countries have adopted policies that emphasize donation after cardiocirculatory death (DCD) in an attempt to address the widening gap between the demand for transplantable organs and the availability of organs from donation after brain death (DBD) donors. In order to examine how these policy shifts have affected overall deceased organ donor (DD) and DBD rates, we analyzed deceased donation rates from 82 countries from 2000-2010. On average, overall DD, DBD and DCD rates have increased over time, with the proportion of DCD increasing 0.3% per year (p = 0.01). Countries with higher DCD rates have, on average, lower DBD rates. For every one-per million population (pmp) increase in the DCD rate, the average DBD rate decreased by 1.02 pmp (95% CI: 0.73, 1.32; p<0.0001). We also found that the number of organs transplanted per donor was significantly lower in DCD when compared to DBD donors with 1.51 less transplants per DCD compared to DBD (95% CI: 1.23, 1.79; p<0.001). Whilst the results do not infer a causal relationship between increased DCD and decreased DBD rates, the significant correlation between higher DCD and lower DBD rates coupled with the reduced number of organs transplanted per DCD donor suggests that a national policy focus on DCD may lead to an overall reduction in the number of transplants performed.
authors.affiliation: The Centre for Values, Ethics and the Law in Medicine, School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. aric.bendorf@sydney.edu.au
authors.forename: Aric
authors.initials: A
authors.lastname: Bendorf
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Kelly
authors.forename: Ian H
authors.initials: IH
authors.lastname: Kerridge
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: McCaughan
authors.forename: Brian
authors.initials: B
authors.lastname: Myerson
authors.forename: Cameron
authors.initials: C
authors.lastname: Stewart
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Pussell
mesh_terms: D001926:Brain Death; D006801:Humans; D038622:Internationality; D016377:Organ Transplantation / Q000706:statistics & numerical data*; D011640:Public Policy; D009927:Tissue and Organ Procurement