Evolution of deceased organ donation activity vs. efficiency over a 15 year period: an international comparison

Background The donation rate (DR) per million population is not ideal for an efficiency comparison of national deceased organ donation programs. The DR does not account for variabilities in the potential for deceased donation which mainly depends on fatalities from causes leading to brain death. In this study, the donation activity was put into relation to the mortality from selected causes. Based on that metric, this study assesses the efficiency of different donation programs. Methods This is a retrospective analysis of 2001–2015 deceased organ donation and mortality registry data. Included are 27 Council of Europe countries, as well as the USA. A donor conversion index (DCI) was calculated for assessing donation program efficiency over time and in international comparisons. Results According to the DCI and of the countries included in the study, Spain, France, and the USA had the most efficient donation programs in 2015. Even though mortality from the selected causes decreased in most countries during the study period, differences in international comparisons persist. This indicates that the potential for deceased organ donation and its conversion into actual donation is far from being similar internationally. Conclusions Compared with the DR, the DCI takes into account the potential for deceased organ donation, and therefore is a more accurate metric of performance. National donation programs could optimize performance by identifying the areas where most potential is lost, and by implementing measures to tackle these issues. Correspondence to: Franz F. Immer, MD, consultant cardiovascular surgeon FMH, Swisstransplant, Effingerstrasse 1/Postfach, CH-3011 Bern, Switzerland., franz.immer@swisstransplant.org **Please refer to Appendix 1, SDC, https://ift.tt/2HDeOT2 for information about Council of Europe European Committee on Organ Transplantation (CD-P-TO) membership Authors' contributions JW: acquired and analyzed data, reviewed the literature, wrote the manuscript; AE acquired and analyzed data, contributed to the writing of the manuscript; BM, provided the donation data from the Newsletter Transplant database; BDG, DA, ANC, BHK, KL: members of the Council of Europe's project TO077 CD-P-TO working group, participated in the study design, revised the manuscript critically; FFI conceived the study, advised on its design and revised the manuscript critically, member of the TO077 CD-P-TO working group. Conflict of interest: The authors declare no conflicts of interest. Funding: This study received no external funding. Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (https://ift.tt/2EZJQTY). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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