Breakdown in the Organ Donation Process and Its Effect on Organ Availability

Table 1

Process breakdowns and determination criteria.

Name	Description	Determination
Missed referral	The OPO was never notified about the deceased.	Unaccounted patient deaths are found during medical/death record review by the hospital development staff.
Untimely referral	The OPO was not notified about the imminent death within 1 hour of such determination, or if the patient has died, within one hour of death.	The donor referral coordinator who receives the call from the hospital verifies the time of imminent death determination, or if the patient has died, the time of patient’s death. These times are then compared with the time when the hospital notifies the OPO.
Suboptimal request for donation	Either the timing of the request is poor or the person requesting donation is not a trained requestor. Poor timing of the request includes discussing donation either before or soon after the family is informed about patient’s death.	These process breakdowns are either self-reported by the hospital staff (e.g., “Dr. Doug mentioned organ donation to the family”) or by the family to the procurement coordinator (“We have been asked about donation and we don’t want to do it”).
Deescalation of care	The referral is made timely but hemodynamic stability is not maintained and life-saving measures are discontinued. Only comfort measures are provided.	While assessing patient’s medical record, the procurement coordinator finds that the patient is on “comfort only” measure.
Early extubation	Initial referral is made on time but the patient is withdrawn from the ventilator before the family is offered the opportunity to donate.	The procurement coordinator records that the patient was removed from the ventilator and passed away before request for organ donation is made to the family.