Missed opportunities in organ donation

Dear Editor,

The recent article “How the mode of organ donation affects family behaviour at the time of organ donation” by Joel Prescott in the Journal of the Intensive care Society (2019; 20(3): 204–207) admirably seeks to bring an evidence base to help address and overcome barriers to organ donation and support families.

The authors highlight data from the NHS Blood and Transplant service to illustrate lower consent rates for donation in deceased after cardiac death, but the most recent figures from the Potential Donor Audit ¹ demonstrate a failure to approach the family (1858 approached out of 4456 (41%) vs. 1066 out of 1471 (72%) families approached in brainstem death). Consent rates were obtained in 60% and 72% of cardiac death (DCD) and brainstem death (DBD), respectively, although the rates of solid organ donation were lower in the DCD group owing to physiological and logistical challenges highlighted in the article.

If we hope to provide for the increasing numbers of patients on the transplant waiting list, then resources might better be focused on assessing the barriers to referral. Squires et al. ² performed a qualitative study, interviewing intensive care doctors, nurses and organ donor coordinators across Canada to establish common factors that either encourage or discourage referral to organ donation. All staff groups reported a lack of education or clear DCD referral criteria, among others as barriers to increasing organ donation.

Supporting and learning from families is important but it remains incredibly important to raise the question of organ donation to far more families than is currently being done, particularly in the DCD group. We would do well to acknowledge our own limitations and recognise the responsibility placed upon the healthcare professional to not deny the opportunity of organ donation. Organ donation discussion should become as necessary as discussions regarding treatment escalations.

With the upcoming changes from an opt-in to opt-out system in the United Kingdom, we will likely see an increased public awareness around organ donation. NHS Blood and Transplant services has announced the running of a public awareness campaign, and we should use this as an opportunity to refresh our own knowledge of the organ donation system. Together, this would hope to increase both the number of referrals by healthcare professionals and the number of approvals from families.