Table 7.
Before and after audit studies of practice change showing association between approach and expertise of person making request for organ donation and consent rate for organ donation. Numbers are percentages of relatives consenting to organ donation when factor was present or not
| Author | No studied | Type of study | Factors associated with consent to organ donation | % consenting | P value | |
|---|---|---|---|---|---|---|
| With factor | Without factor | |||||
| von Pohle et al,w7 1996, US | 61 before, 35 after | Retrospective chart review | Rate of donation increased with addition of institutionally dedicated organ procurement organisation representative and routine use of decoupling | 38 | 59 | <0.05 |
| Helms et al,w11 2004, US | 164 before, 137 after | Prospective collection of data compared with data before installation of neurointensivist led team | Consent rate increased after policy change in unit (uncoupling and removal of treating physician from donation requests; request made by procurement officer) | 23 | 37 | 0.01 |
| Consent rates for donations in NCCU after policy change, were significantly higher than in other intensive care units in same hospital (36.5% v 22. 4%, P=0.003) | 37 | 22 | 0.003 | |||
| Shafer et al,w12 1998, US | 313 before, 112 after | Retrospective study before and after implementation of in-house coordinator in hospital with level 1 trauma centre | Implementation of in-house coordinators: consent rate increased | 45 | 74 | <0.001* |
| Shafer et al,w13 2003, US | 770 before, 2284 after Includes data from refw12 | Retrospective evaluation of in-house coordinator programme in 2 hospitals with trauma centres | Placement of in-house coordinators within trauma centres: consent rate averaged 67%, representing 37% increase above period before in-house coordinators | 49 | 67 | <0.001* |
| Trauma centres with in-house coordinators had 28% greater consent rate and 48% greater conversion rate of potential donors to actual donors than other 85 level 1 trauma centres | NA | NA | NA | |||
| Riker et al,w16 1995, US | 155 before, 49 after | Non-randomised, controlled, before and after intervention trial | Evaluated consent rate after two 1 hour educational sessions with emergency physicians v control group of consulting physicians. After intervention emergency physician consent rate increased from 0% to 32% (P<0.001) but control group consent rate increased from 2.6% to 6.6% | 0 | 32 | NC |
| Linyear et al,w15 1999, US | 42 before, 47 after | Retrospective medical record review; observational study after implementation of family support and communication protocol | Protocol: private setting; decoupling; request by OPO with family communication coordinator/hospital staff | 49 | 72 | NA |
| Consent rate 67% for May and June v 31% for July to December (new residents) | 67 (experienced residents) | 31 (new residents) | NA | |||
| Salim et al,w17 2007, US | 287 before, 208 after | Retrospective analysis of patients referred to regional OPO for possible organ donation comparing family consent rates before and after implementation of in-house coordinator programme | In house coordinator associated with higher consent rate | 35 | 52 | <0.01 |
NCCU=neurosciences critical care unit; NA=not available, data not given; NC=not calculable; OPO=organ procurement organisation.
*Calculated from published data.