Retrospective data analysis reveals a sustained increase in referral of potential deceased organ donors to Transplant Coordinators in Groote Schuur Hospital

Context

More deceased donors are required to address the critical need for organs in South Africa. Deceased organ donation is, among other factors, dependent on the referral by treating doctors of brain stem dead, or near brain stem dead patients, to transplant coordinators as potential organ donors.

The Problem

It is not mandatory for treating doctors to refer brain stem dead, or near brain stem dead patients, to the transplant coordinators, hence many potential organ donors are lost.

Over the years, many strategies were put in place to try and increase the amount of potential organ donors. However the referral and consent process at Groote Schuur Hospital had not been routinely tracked in a way that could provide insight into the strengths and weaknesses of the process, nor into the changes related to various inputs over time.

The Aim

To change the way the organ donation data is displayed so that a valid analysis can be made of the organ procurement over time.

Methodology

A retrospective, longitudinal analysis of routine monthly data (July 2012- May 2015) was done to assess the organ donation consent process at the hospital including: referral of potential donors to the organ transplant coordinators; approaches to families by the coordinators; request for consent from the families; with the outcome being the number of successful consents. Data was displayed as line graphs and the median performance of the system assessed by adding a baseline median for the first 12 months (2012) and applying Run Chart Rules a against the baseline.

Results

A sustained improvement in the referrals system was noted from the end of 2013 resulting in double the median number of consents for organ donation per month from one to two. Significant increases in median performance were noted for a number of steps in the referral and consent process:

Total referrals increased 60% (from a median of 5 to 8 referrals per month) (Figure 1.1). While referrals did not increase from medical casualty (remaining at a median of two per month), a significant increase of 25% was noted from trauma unit (from a median of three to four referrals per month), and a 50% increase from all other referral sites combined (from a median of 0.5 to one referrals per month).

The percentage of referrals that were approached increased by 81.7%, (from a median of 36.7% to 66.7% per month) and the number of approaches increased by 150% (from a median of two to five month) (Figures 1.2 and 1.3 respectively.)

Lessons Learnt

Although data on the organ consent process is routinely available, it had not previously been tracked visually over time. Improvements in various process steps, that started 18 months prior to the study, were therefore only identified retrospectively.

Understanding changes in the system that doubled the number of referrals for potential deceased organ donations helped the transplant coordinators to understand which interventions were valuable and which weren’t.

Prospectively tracking process and outcome data as line graphs could possibly identify identify powerful best practices that could allow these important changes to be identified in a more timely way. Lessons learned at this hospital on the value of displaying data visually, may be applicable to national data on deceased organ donation that is traditionally presented as a table of raw data and improve access to a rare and life saving resource.

GRAPHS MISSING