Institutional variability in brain-dead organ donation processes and practices: A multicenter retrospective cohort study in Japan
Tetsuya Yumoto1, Hiromichi Naito1, Mineji Hayakawa2, Shoji Yokobori3, Kei Nishiyama4, Takahiro Atsumi5, Osamu Tasaki6, Atsunori Nakao1.
1Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan; 2Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan; 3Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan; 4Division of Emergency and Critical Care Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; 5Department of Emergency and Disaster Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan; 6Acute and Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
J-RESPECT study group.
Background: A severe worldwide organ shortage persists. In Japan, a major challenge is the substantial variability in organ donation activity across hospitals; however, comprehensive data on hospital-level practices remain limited. This study aimed to examine key institutional and clinical factors by comparing extremely and highly active donation hospitals, offering a comprehensive assessment of organ donation processes in Japan.
Methods: This was a retrospective, multicenter cohort study conducted across 16 tertiary emergency and critical care centers in Japan. We included all brain-dead organ donors who had at least one organ procured and transplanted between July 17, 2010, and December 31, 2023. Institutions were categorized into 2 groups based on the number of brain-dead organ donations performed during the study period: extremely active (≥14 donations) and highly active (≤13 donations). We compared the organ donation process, including patient characteristics, donor management, timeframes, and multidisciplinary team meetings, between the 2 groups.
Results: A total of 204 brain-dead donors (21.8% of all cases nationwide) were included, with 96 from 5 extremely active institutions and 108 from 11 highly active institutions. The median age was 47 years (IQR: 37–56), and 92 (45.1%) were female. Patient characteristics were similar between groups. Almost all donors received vasopressin, but dose variations were significant, and corticosteroid use was higher in extremely active institutions (58.3% vs. 38.0%, p=0.004). While the timeframe from admission to coordinator notification was similar, the interval to family consent (8 vs. 5 days, p<0.001) and organ procurement (12 vs. 9 days, p=0.006) was longer in extremely active institutions. Multidisciplinary team meetings during donor management were more frequent in extremely active institutions (2 vs. 0, p<0.001).
Conclusions: Significant differences in donation practices, donor management, and timeframes were observed between extremely and highly active institutions. These findings highlight the need for standardized protocols to optimize donor care, improve efficiency, and streamline the organ donation process.
[1] Brain Death, Critical Illness, Decision Making, Organ Transplantation, Patient Care