Strategies to increase organ donation

Abstract

With the increasing prevalence of kidney failure, demand for kidney transplants outpaces kidneys available for transplantation. People who die in hospital under appropriate circumstances may be considered for potential organ donation. If their family consents and they are medically suitable, they become an actual donor. Efforts to increase potential donors have not translated to more actual donors. Potential donors declined due to perceived cancer transmission risk may be suitable under donation guidelines, presenting an avenue for increasing donation.

Relying on SAFEBOD data (donors and recipients linked to health records), this thesis sought to: 1) identify missed opportunities for donation from deceased donors with perceived cancer, 2) evaluate the risk of receiving a transplant from a donor with cancer, 3) develop an economic model to assess the cost-effectiveness of strategies to increase utilisation of kidneys from deceased donors with brain cancer, and 4) explore variations to this model.

Decisions about donors' medical suitability are often made with imperfect information (e.g., cancer reported by next-of-kin but not confirmed in health records). Among those declined due to perceived cancer, 29% were verified suitable (missed opportunities). Possible interventions are: 1) decision support, 2) real-time data-linkage, and 3) more risk tolerance. Cancer transmission is rare, especially from donors with brain cancer. No brain cancer transmissions were identified in SAFEBOD, and risk estimates are based on case reports. The economic model showed transplanting more kidneys from brain cancer donors improves health outcomes and saves money. More risk tolerance (accept grade IV brain cancers: 6.4% transmission risk) provides the most benefit, +18.6 quality-adjusted life-years (QALYs) and $2.2m savings. Findings were robust to rigorous scenario and sensitivity analyses.

Accepting more donors with brain cancer could increase donation and improve patient outcomes.