Identifying opportunities to increase organ donation rates in Australia

Abstract

Transplantation is the optimal therapy for end-stage organ failure, but the utility of this intervention is limited by a critical shortage of donor organs. This research sought to examine opportunities to improve the donor referral process, and to increase donation rates.

Chapter 2 Increased organ donation rates have been exceeded by a rise in referral of potential organ donors for evaluation. This study sought to characterise potential organ donor referrals in NSW and identify factors associated with non-donation through a retrospective cohort study of NSW OTDS referral logs 2010-2015. Comorbidity prevalence was described, and logistic regression used to identify comorbidities influencing referral outcome and determine predicted probability of donation. Most comorbidities increased in prevalence over time. Comorbidity burden was higher among non-donors than donors. Significantly (p<0.01) associated with non-donation were age >65, and history of malignancy, or cardiac, kidney or liver disease. Predicted probability of a referral donating varied <1% to 54% with comorbidity burden. As donor referral volumes increase, understanding characteristics associated with non-donation may improve the efficiency of the referral process.

Chapter 3 Although the risk of primary brain tumour (PBT) transmission via organ donation and transplantation is low, some donor referrals with PBTs may be declined due to concerns regarding biovigilance. This retrospective cohort study aimed to describe transmission risk and donation outcome of referrals with PBT and transplant recipients 2010-2015. Referrals were characterised and data linkage was used to identify any transmission of PBT from donor to recipient. Of 76 PBT referrals, 18 (24%) were declined due to perceived PBT transmission risk and 10 (13%) donated. All PBT donors had WHO-I or -II tumours. No events of PBT transmission were identified. There exists opportunity to increase donation rates through utilisation of PBT referrals.