Abstract
Background: Despite appropriate legislation and adequate financial coverage, organ donation rates in Chile remain low. Experts blame high familial refusal rates, while dismissing the effect of procurement process inefficiencies. Our objective is to study some of those inefficiencies.
Methods: Using a two-step approach, we started by obtaining two datasets, hospital discharges and organ procurements between years 2013-2017. We considered all patients that entered the system with a critical neurological condition according to ICD10, and exited dead; and all possible organ donors who entered procurement follow-up. Second, we administered a survey on healthcare professionals (physicians and registered nurses) in ER and ICU of 3 large hospitals in the capital, which aimed at describing procurement process knowledge and behavior. We used descriptive statistics for the analysis of both approaches.
Results: At the first analysis we found that 87% of patients qualifying as possible donors never entered procurement follow-up and, as 50% of families refused to donate, 6% of all possible donors became effective organ donors.
The survey was answered by 88 professionals. 50% physicians, 70% from ER. 51% declared they’ve actively detected a possible donor but 43% referred them to the Local Procurement Coordination. 10% of the surveyed population was not sure about the validity of brain death diagnosis, and 52% never received formal training on any organ donation topic while studying. 73% thought procurement activity was important, but 40% declared not knowing enough about it. ICU professionals were more knowledgeable than ER (81% vs 23% declared more than sufficient knowledge, p<0.001).
Conclusions: The insufficient knowledge of procurement activity and concepts, especially from ER professionals may explain the lack of possible donor detection and referral found at a national level. Although the small sample may not be fully representative of the target population, the findings provide the insight that the efforts to increase Chilean organ donation rates should be put in educating healthcare professionals that participate in the procurement process, or even automating and standardizing the process to stop relying on people’s knowledge.