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ncrease in Organ Donation Rate in a Swedish Region Aftermplementing a New Angle of Approach

.I. Gustafsson, A. Wolfbrandt, S. Dahlman, and L. Mjörnstedt

ABSTRACT

In the Swedish Västra Götaland region (1.65 million inhabitants), we have implemented,as from January 1, 2006, a new concept to improve the organ donation rate, which in 2005was 13.9 per million population (PMP). There are two cornerstones in the project: a new,active role for the transplant coordinators and the establishment of a uniform policy for thecare of potential donors as well as criteria for the decision to offer intensive care in variouscritical conditions. The coordinator is now contacted at an early stage and is in place whenthe brain death diagnosis is underway or completed. The coordinator is thereafter aresource for all aspects of the care of the potential donor/donor, and also in the contactwith the relatives. To date (May 2006) the donation rate has reached 23.6 PMP annually

(a 70% increase).

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HE ORGAN donation rate from deceased donors inSweden is low, despite an ever-increasing need for

ransplantable organs. In 2005, the rate was 14.2 per millionopulation (PMP). Over the years, attempts have beenade to increase this rate by means of information cam-

aigns to the general public and health care personnel, aational donation registry, and different local initiatives.owever, the effects have been minor and/or transient. On

he other hand, in Spain and some regions in Austria andtaly, donation programs including the active use of spe-ially trained physicians and transplant coordinators haveeen successful.1–3 We wanted to introduce some changes

n our organization considering the local conditions toncrease the organ donation rate.

UBJECTS AND METHODS

n the Swedish Västra Götaland region (1.65 million inhabitants),e have implemented, as from January 1st 2006, a new concept to

mprove the organ donation rate, which in 2005 was 13.9 PMP. Inhe region, there is one university hospital where all transplanta-ions are performed and eight county hospitals with intensive carenits (ICU). The start was preceded by information visits to allCUs in the region to gain approval for the purposes and theroject design. There are two cornerstones to the project: thestablishment of a uniform policy for the care of potential donorss well as criteria for the decision to offer intensive care in variousritical conditions and a new, active role for the transplant coordi-ators. The first part is complex; the prerequisites are very differentetween hospitals. Our ambition is that guidelines for the initialare of patients with intracranial hemorrhage and other brain

njuries will be established. The second part, which has been G

2006 by Elsevier Inc. All rights reserved.60 Park Avenue South, New York, NY 10010-1710

ransplantation Proceedings, 38, 2625–2626 (2006)

mplemented from the start, means that the transplant coordinators contacted earlier and is in place when the brain death diagnosiss underway or completed. The coordinator functions as a resourceerson for all aspects of the care of the potential donor/donor,

ncluding approaching the family.

ESULTS

etween January 1 and April 30, 2006, there were 13ealized donors in the region (Table 1). The patientonsent was known in seven cases, of which one wasbtained from the national donation registry, and in theemaining six, there was a family non-veto. The donationate was 23.6 PMP per year.

ISCUSSION

here are several factors that, when taken together, mayxplain the low Swedish organ donation rate. It is likely thatigh standards of traffic security and advances in neurosur-ery and intensive care contribute to this. Loss of potentialonors can be due to lack of resource allocation to ICUs,ut a more important reason seems to be that intensivistsnd neurosurgeons often have a neutral instead of arodonation approach. Other identified obstacles for organonation are ethical problems or controversies, as well as

From the Department of Transplantation and Liver Surgery,ahlgrenska University Hospital, Göteborg, Sweden.Address reprint requests to Dr B.I. Gustafsson, Department of

ransplantation and Liver Surgery, Sahlgrenska University Hospital,

öteborg, Sweden. E-mail: bengt.gustafsson@surgery.gu.se

0041-1345/06/$–see front matterdoi:10.1016/j.transproceed.2006.07.040

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2626 GUSTAFSSON, WOLFBRANDT, DAHLMAN ET AL

arying competence in clinical death diagnosis.4 In this pilottudy, we wanted to investigate if a facilitation of theonation process could be achieved by the establishment ofniform policies and an extended role for the transplantoordinators within our health care region. A policy documentor the initial care of patients with suspected or diagnosedntracranial hemorrhage is under preparation in cooperationith the different clinical departments involved in the process,amely, neurology, emergency medicine, and anesthesiol-gy. The primary goal is to save lives and reduce secondaryrain damage, and the second to render possible an optimalrgan donation, with all due medical, ethical, and legalonsiderations.

The present study was designed for a region with an areaf about 25,000 km2, where the hospitals are reached withinhours’ travel by car. The 2 university hospitals and 20

ounty hospitals in the Swedish southeast and nordic healthare regions (1.86 million inhabitants) that are part of the

Table 1. Donors in the Västra Götaland Region, Sweden,January to April 2006

otential donors 15Objection during life 1Medical reason for no donation 1Family veto 0

ealized donors 13 (9 men, 4 women)Median age (yrs) 61 (range, 15–77)Intracranial hemorrhage 11Cerebral infarction 1Cardiac arrest 1Trauma 0rgans transplanted 43 (3.3/donor)

ame organ procurement and transplantation organizationd3

ere not included owing to logistic and economic reasons.s a comparison, the donation rate in these regions was

6.1 PMP in 2005. The transplant coordinator’s new role asresource person has generated extra working time, esti-ated to 4–5 hours per donor. Much of the work previously

one by phone has now been performed locally and thempression is that the total time from first contact toompleted donation thereby has been shorter. Moreover, inhe process of approaching the relatives before and afterhe completed death diagnosis, the coordinator has ofteneen able to support and complement the local physician. It

s likely to assume that this has contributed to a moreprodonation” atmosphere. Interestingly, no family has ex-ressed veto to donation. The results after four months shown increase in organ donation from 13.9 to 23.6 PMP per year.n the other Swedish transplant regions, the rates this year varyrom 13.9 to 16.1. Although the total number of donors is toomall to allow for any far-reaching conclusions, we believe thathe good results so far are related to a higher level of donationwareness and the changed way of working. A more thoroughnalysis is planned after 1 year.

EFERENCES

1. Matesanz R, Miranda B: A decade of continuous improve-ent in cadaveric organ donation: the Spanish model. J Nephrol

5:22, 20022. Zink M, Toller W, Stadlbauer V, et al: An effective way to

xpand the heart-beating donor pool. Transpl Int 17:553, 20043. Matesanz R: Factors influencing the adaptation of the Span-

sh Model of organ donation. Transpl Int 16:736, 20034. Sanner M, Nydahl A, Desatnik P, et al: Obstacles to organ

onation in Swedish intensive care units. Intensive Care Med2:700, 2006