Squires et al conducted a systematic review of the international literature to investigate the effectiveness of donation physicians in improving organ donation outcomes. The review included 12 quantitative studies reporting on organ donation outcomes from donation physicians’ involvement. These outcomes included potential organ donors (increase between 8%-143% in potential organ donors following implementation of donation physicians) and actual organ donors (increase between 15%-113% in actual organ donors). Other metrics increasing included donor consent rate, organ procurement and transplants. Though there are many factors improving system performance, findings from this review highlighted that donation physicians are key to improve deceased organ donation and further studies should focus on implementation and evaluation of such programs.

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Interviews related to organ donation with family members are challenging, and when the decision involves children and adolescents the topic can be even more sensitive, and therefore a care bundle can be an important resource to support health care professionals during the conduction of family interviews. Knihs and colleagues conducted a three-phase study with a literature review, qualitative interviews (healthcare professionals, n=17; family members, n=9), and an expert committee (n=5) review to develop a care bundle. The care bundle developed included three categories: communication of death, emotional support and information about organ and tissue donation. The authors offer comprehensive guidance on the care strategies for each of the categories to assist healthcare professionals to increase the quality of family interviews and impact the reduction of family refusals.

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Organ donation disparities among Asian Americans have persisted over years, and although this population has significant transplantation needs, they have the lowest organ donation rates in US. Therefore, Siminoff and colleagues developed a culturally and linguistically tailored video using a family appeal among Asian Americans to promote organ donation awareness. The video development involved a 12-member community effort, and the content was informed by a previous qualitative focus group study. The video was distributed on social media platforms and metrics were tracked for evaluation. Results highlighted that in six months the video reached 36,845 Asian Americans and the engagement was higher in Facebook and paid approaches. The findings from this study show that the use of social media can be an effective communication strategy to increase organ donation awareness among Asian Americans, particularly females over 45 years of age and help reducing the organ donation disparities among ethnic minorities.

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As donation programs increase referral rates, transplantation systems are forced to consider more donors whose organs are at increased risk of graft dysfunction or failure – advanced age, increased comorbidities, etc. – which puts pressure on systems to improve utilization rates. However, the best measures of organ utilization are unclear, an issue highlighted in this report from Schutter et al. from the Netherlands. Using Dutch and European databases from 2015-2020, this group reviewed the recorded reason for non-utilization of every potential kidney transplant in the Netherlands. In doing so, they showed that the traditionally reported non-utilization metric of discard rates – percentage of recovered but not transplanted kidneys – substantially underestimated the number of non-utilized referred donors. Many of the reported reasons for non-utilization were somewhat or wholly subjective such as undefined “poor organ quality”. The group called for increased standardization of reasons for non-utilization. Donation practitioners and systems should participate closely in these decisions and ensure that information is communicated in a way that encourages maximal, safe utilization of all potential donors.

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Terminal Extubation (TE), is the withdrawal of ventilatory support from terminally ill patients. Although TE and its natural progression to death provides closure to the suffering for patient and the family, the healthcare system lacks the tools to serve that purpose. This also negatively affects donation after cardiac death organ donation efforts. To this end, Huang et al aimed to develop an advanced machine learning model, long-short term memory (LSTM) to accurately predict death within 2 hours post-TE and compare to the standard clinical prediction score. Clinical, laboratory and demographic data from 1,965 patients were collected 24 hours before TE. Results indicate that the LSTM model outperformed the clinical prediction score (0.66 vs 0.51 p=0.001) to accurately predict death within 2 hours of TE. This information will facilitate end of life discussions, improve organ donation rates and help in operationalizing allocation of Intensive Care Units (ICU) resources efficiently.

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