Big Hearts and Organ Donations Soar Across Midwest

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21 Americans die each day waiting for organ transplants; more than 123,000 are waiting right now. A new study from Penn Medical researchers shows that family consent rates for organ donation vary widely across the US, disputing the notion that race is the most important factor. Donation rates are lowest in New York State and highest in the Midwest.

"These findings dispute the commonly held notion that the gap in donor supply in certain geographic areas is due to large populations of racial and ethnic minorities who are less likely to consent for donation, thus affecting the geography of available organs," says lead author David Goldberg, MD, MSCE, an assistant professor in the division of Gastroenterology at Penn.

The researchers, from the Perelman School of Medicine at the University of Pennsylvania and the University of Kansas Hospital, published their results in the most recent issue of the American Journal of Transplantation.

The researchers analyzed data from the the nation's organ transplant network, Organ Procurement and Transplantation Network (OPTN) and United Network for Organ Sharing (UNOS). They found that between 2008 and 2013 more than 52,500 people eligible for organ donation died. "Eligible" means that they were brain dead, no older than age 70, and were not suffering from serious medical conditions. Among these cases, 73 percent of families and next of kin consented to organ donation.

The families of white patients under the age of 55 who were contacted in a "timely" manner consented to organ donation most frequently. The next of kin of African Americans, Asians, and Hispanics were in fact less likely to consent, but these differences did not account for the wide geographical variability overall. Even when the researchers adjust for other factors like race and location, donor rates varied from 64 and 90 percent in the various donor service areas.

The researchers point out that of the most concern is the fact that within each area consent rates were only around 75 to 80 percent-and in about one-quarter of the areas the rates fell below 70 percent. This means that across the board, consent rates should ideally be higher.

"These data demonstrate that although the underlying demographics of the donor population may contribute to geographic differences in organ consent rates, it clearly is not the major driving factor," Goldberg says. "Although there may be underlying cultural or religious differences leading to variable consent rates, the dramatic differences in consent rates among younger Caucasians clearly show that race alone cannot explain geographic differences in organ donor consent rates."

The researchers point out that if areas of lower consent rates increased their rates to match the median rate, there would possibly be a pool of 773 more donors available. That group could yield almost 2,700 critical organs for transplant including hearts, intestines, kidneys, livers, pancreases, and lungs.

"Importantly, nearly one third of these increased donors would come from the donor service areas in New York State," Goldberg says. "This is of critical importance to the liver transplant community, the OPTN, and HRSA, as there are proposals currently being evaluated to redraw the maps for how organs are distributed. Yet efforts to increase donation rates, most notably in New York, would save more lives, increase the number of transplants, and potentially cost much less than efforts to more broadly share organs across the nation."

The study was prompted by the overwhelming need for more organ donors in the US (and worldwide).

"With over 10,000 patients a year dying on a transplant waiting list or becoming too sick to undergo a transplant, these data highlight the potential opportunity to save hundreds of more lives each year by increasing consent rates among potential organ donors," says senior author Richard Gilroy, MD, University of Kansas Hospital medical director of Liver Transplantation. "By increasing organ donor consent rates, and optimizing how we utilize a scarce resource, the transplant community can help OPTN achieve its highest priority of increasing the number of transplants each year in the US."

So, what can be done? The researchers propose an approach that takes more than one tactic. Broader community engagement, concentrated efforts by organ donation hospitals, engagement with and education for potential donors and their next-of-kin and families, along with strategic optimization in the existing management of organ donation on the part of organ procurement organizations are all essential to success.

"Efforts to increase organ donor consent rates by all parties should be a major focus of the transplant community and the general public," Goldberg says. "This is the only mechanism that will allow us to prevent waitlist deaths while increasing the number of transplants."