title: Identifying opportunities to increase organ donation after brain death. An observational study in Sweden 2009-2014.
abstract: BACKGROUND
  There is a wide gap between the number of organ donors and patients on waiting lists for transplantation. The purpose of this Swedish nationwide study of the critical pathway for organ donation after brain death (DBD) was to identify missed opportunities for organ donation.
  
  
  METHODS
  We performed a prospective, observational study of all ICU deaths in Sweden from Jan 1, 2009 to Dec 31, 2014. The protocol structure followed the critical pathway for organ donation, which was developed and tested during 2008. We analysed differences in donation incidences between healthcare providers (counties) and patient characteristics using descriptive statistics and logistic regression.
  
  
  RESULTS
  The number of DBD per million population (pmp) was 14.9, varying almost 10-fold from 4.3 to 40.6 DBD pmp between counties. Regional variation in DBD decreased when we assigned the donor to the place of residence (from 6.9 to 27.7 DBD pmp). Women were more likely to become donors compared to men [crude odds ratio (OR) 1.60, 95% confidence interval (CI) 1.38-1.85, P < 0.001]. The increased likelihood remained after adjusting for age, comorbidity, and main diagnostic categories (OR 1.49, 95% CI 1.25-1.77, P < 0.001). An end-of-life decision was found in 50.9% of possible organ donors.
  
  
  CONCLUSIONS
  Regional differences in DBD were considerable, and women were more likely to become donors than men. There is a need for increased awareness of the potential for organ donation as an integral part of end-of-life clinical care. In-depth analysis of these differences may reveal opportunities for action that could lead to increased DBD.
authors.affiliation: Department of Anaesthesia and Intensive Care, Central Hospital, Kristianstad, Sweden.|The Swedish Intensive Care Registry, Karlstad, Sweden.
authors.forename: T
authors.identifier: http://orcid.org/0000-0002-1313-0301
authors.initials: T
authors.lastname: Nolin
authors.affiliation: The Swedish Intensive Care Registry, Karlstad, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Mårdh
authors.affiliation: The Swedish Intensive Care Registry, Karlstad, Sweden.|County of Värmland, County House, Karlstad, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Karlström
authors.affiliation: Department of Cardiovascular Anaesthesia and Intensive Care and Department of Medicine and Care, Linköping University, Linköping, Sweden.
authors.forename: S M
authors.initials: SM
authors.lastname: Walther
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017678:Sex Distribution; D013548:Sweden; D013727:Terminal Care; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*