Factors Related to the Low Organ Donation Rate - A Transplant Management Approach

Pimenta, Graziele Jacob; Carneiro, Sueli Coelho da Silva; Fontenele, Andréa Martins Melo; Jacob, Gisele; Cruz, Ana Cássia Martins Ribeiro; Veiga, Angela Ines Brito

doi:10.53855/bjt.v27i1.615_PORT

Brasil

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ORIGINAL PAPER • Braz. J. Transplant. 27 • 2024 • https://doi.org/10.53855/bjt.v27i1.615_ENG linkcopy

Factors Related to the Low Organ Donation Rate - A Transplant Management Approach

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To assess the capacity to identify potential organ donors in a university hospital in Maranhão (MA).

Methods: The study is a retrospective, quantitative cohort based on the documentary analysis of medical records of deceased patients in the adult intensive care units (ICUs) of a university hospital in MA from 2018 to 2019. Screening Instrument I from the Organización Nacional de Trasplantes (ONT) of Spain, based on Avedis Donabedian and validated in Brazil, was used to identify potential donors with clinical signs of brain death (BD). The analysis involved reviewing medical records and applying BD diagnostic criteria, according to Conselho Federal de Medicina Resolution nº 2,173 of 2017. A total of 312 records were analyzed, resulting in 38 with signs of BD, classified as escapes due to identification and maintenance failures of potential donors.

Results: Of the 312 evaluated records, 21 from 2018 and 17 from 2019 (totaling 38) presented clinical signs of BD and were selected for detailed auditing.Additionally, it was identified that 31.1% of the escapes or losses of potential donors resulted from deaths not identified as BD, generating previously unknown indicators. The tool revealed that patients undergoing surgical treatment for brain tumors and cerebrovascular diseases have a higher likelihood of evolving to BD. These patients, usually admitted to the general ICU, should receive special attention in daily assessments due to their high potential to become organ donors.

Conclusion: The audit highlighted the need for improvements in the identification and maintenance of potential donors, as well as in reducing family refusals, to increase the number of effective donations.

Descriptors Transplant Management; Potential Donor; Brain Death; Transplant Quality

Description	2018	2019	General
n sample	21	17	38
Minimum	20.0	35.0	20.0
Maximum	78.0	72.0	78.0
Median	55.0	53.0	55.0
First quartile	45.0	49.0	47.0
Third quartile	65.0	64.0	64.7
Arithmetic mean	53.3	55.1	53.5
SD	16.4	10.3	13.9
Coefficient of variation (%)	31.9	18.0	26.8
p value (normality)	0.1341	0.5267	0.0896

Evaluated condition	2018 (n = 21)		2019 (n = 17)		General (n = 38)		2018 × 2019	Trend
Evaluated condition	n	%	n	%	n	%	p-value
Location of diagnosis							0.2069	< 0.0001^* * Statistical relevance.
cardiological ICU	5	23.8	3	17.6	8	21.1
general ICU	13	61.9	14	82.4	27	71.1
Others	3	14.3	0	0.0	3	7.9
Age range (years)							0.4443	0.0193^* * Statistical relevance.
20 to 29	3	14.3	0	0.0	3	7.9
30 to 39	2	9.5	1	5.9	3	7.9
40 to 49	2	9.5	5	29.4	7	18.4
50 to 59	5	23.8	4	23.5	9	23.7
60 to 69	7	33.3	6	35.3	13	34.2
over 70	2	9.5	1	5.9	3	7.9
Gender							0.7923	0.2561
Female	12	57.1	11	64.7	23	60.5
Male	9	42.9	6	35.3	15	39.5
Death							0.0962	0.0007^* * Statistical relevance.
Yes	7	33.3	1	5.9	8	21.1
No	14	66.7	16	94.1	30	78.9
Cause of death							0.3346	0.4223
Anoxia/CRA	5	23.8	0	0.0	5	13.2
Hemorrhagic stroke	3	14.3	4	23.5	7	18.4
Ischemic stroke	2	9.5	1	5.9	3	7.9
Post-surgery bleeding	3	14.3	2	11.8	5	13.2
Other	4	19.0	6	35.3	10	26.3
Tumor	4	19.0	4	23.5	8	21.1

Evaluated condition	Escape (n = 35)		p-value	Transplant (n = 3)		General (n = 38)
Evaluated condition	n	%	p-value	n	%	n	%
Possible donor			< 0.0001^* * Statistical relevance.
Yes	31	88.6		3	100.0	34	89.5
No	4	11.4		0	0.0	4	10.5
Gasgow ≥ 3			< 0.0001^* * Statistical relevance.
Yes	35	100.0		3	100.0	38	100.0
No	0	0.0		0	0.0	0	0.0
Apperceptive coma			< 0.0001^* * Statistical relevance.
Yes	35	100.0		3	100.0	38	100.0
No	0	0.0		1	33.3	1	2.6
Absence of cough reflex			< 0.0001^* * Statistical relevance.
Yes	34	97.1		3	100.0	37	97.4
No	1	2.9		0	0.0	1	2.6
Potential donor			0.9999
Yes	17	48.6		2	66.7	19	50.0
No	18	51.4		1	33.3	19	50.0
Medical record identified by CIHDOTT			0.4991
Yes	15	42.9		2	66.7	17	44.7
No	20	57.1		1	33.3	21	55.3
Cause of escape			0.0199^* * Statistical relevance.
Causes ignored	3	8.6		0	0.0	3	7.9
Incorrect medical contraindication	2	5.7		0	0.0	2	5.3
Instability to start BD diagnosis	4	11.4		0	0.0	4	10.5
Unidentified BD	11	31.4		0	0.0	11	28.9
Logistical problems	2	5.7		0	0.0	2	5.3
Maintenance issues	7	20.0		0	0.0	7	18.4
Family refusal	4	11.4		0	0.0	4	10.5
No criteria for BD	1	2.9		0	0.0	1	2.6
The donor (tumor)	1	2.9		0	0.0	1	2.6
Does not apply	0	0.0		3	100.0	3	7.9

In-hospital BD management	Cardiological ICU n (%)	General ICU n (%)	Excellence %
Generating capacity	8/312 (2.56)	30/312 (9.61)	54.50
Causes of losses
Ignored	0 (0.0)	3 (10.0)	0
Logistical problems	0 (0.0)	2 (6.6)	< 1
Maintenance issues	8 (100.0)	16 (53.3)	< 3
Refusal to donate	0 (0.0)	4 (13.3)	10
Actual effectiveness	0 (0.0)	3 (10.0)	> 65

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[1] Source: Elaborated by the authors

[2] p-value (2018 × 2019) = 0.5411, Student's t-test.