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...that are associated with rates organ donation at U.S. hospitals. We analyzed two years of data on the numbers of actual and potential donors at U.S. hospitals to discern whether hospital or market attributes are directly related to a hospital's rate of securing organ donations. We found that certain hospital characteristics are related to higher donation rates. Further research and a deeper understanding of organizational and environmental influences on the complex nature of securing organ donations are needed to help alleviate transplantation waiting lists.
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Although untapped potential exists to increase organ donation rates, current attempts to meet demand for organs are falling short. The number of people waiting for donor organs increases by between 12 percent and 19 percent each year (Joint Commission 2004; OPTN/SRTR 2006). The need for organs increases by approximately 17,000 organs per year (in addition to the large number of organs needed for patients already on waiting lists), and the total number of potential new donors increases by only 13,800 per year. Only 12 percent to 20 percent of potential new donors will consent to donate their organs (Bogan, Rossen, and Peterson 2000). In spite of continued efforts to increase the availability of transplantable organs, wait times are so long that the median time to transplant for registrants after 2001 cannot be calculated because most registrants remain on the list. By the end of 2005, more than three times the number of patients receiving transplants that year were still on the waiting list and approximately 20 waiting patients died each day (OPTN/SRTR 2006).
Published research on the factors influencing consent for cadaveric organ donation has focused on the role and actual behavior of the staff of hospitals and organ procurement organizations (1) (OPO) as well as the characteristics of potential donors and their families. Many processes for seeking consent for organ donation have been put forward as "best practices" in an attempt to improve the donation rate. However, little is known about how, if at all, the characteristics of hospitals influence organ donation rates. How do organizational characteristics reflect an organization's commitment to and support of organ donation/transplantation programs, especially in the face of competing strategic demands? Similarly, characteristics of the hospital's environment and market might influence its focus on organ donation programs and its success at obtaining consent for organ donation. By understanding the organizational and environmental characteristics that are associated with better rates of organ donation, hospital executives will be better informed and be able to support their own organ transplant/donation programs. Leadership is crucial to establishing a culture and commitment aimed at improving organ donation rates (Joint Commission 2004).
The purpose of this article is twofold: (1) to provide a summary of research to raise awareness among healthcare executives of critical factors that affect rates of organ donation and (2) to summarize our exploratory examination of the relationship of hospital and market characteristics to numbers of eligible and actual organ donors and donation rates. We examined these relationships over a period of two years, and our results provide insights for further research and some tentative recommendations for hospital executives' efforts to improve rates of consent for organ donation in their organizations.
FACTORS AFFECTING ORGAN DONATION
Increasing the numbers of organs donated requires two things: (1) maintaining life support for potential donors to ensure the viability of organs and (2) obtaining consent from the donors' families (Roth et al. 2003). This article does not address the medical processes required to maintain the viability of potential organ donations; rather, it focuses on the complex issues surrounding obtaining consent for organ donation--factors that can be influenced by interpersonal and organizational factors. Published studies on factors that affect cadaveric organ donation have focused on the role of the staff of hospitals and OPOs, on the characteristics of potential donors and their families, and on how donation requests are made. In particular, studies have focused on four dimensions:
1. Communication issues affecting potential donor families when they are suddenly confronted with the traumatic scenario demanding a donation decision
2. Potential donor and donor family characteristics, such as demographics, ethnicity, religious beliefs, and attitudes toward the medical community
3. The clinical environment of the hospital, and hospital procedures affecting potential donor families and the donation request process
4. Other situational factors, including hospital and market characteristics
Communication Issues and the Donor Family
Paying special attention to the potential donor family (Exley, White, and Martin 2002; Delong et al. 1998) and implementing a specific communication protocol in the request process--a "best practices" approach--have increased donation and consent rates (Labb 2005; Ehrle, Shafer, and Nelson 1999; Linyear and Tartaglia 1999). Using understandable language and a personal, empathetic approach in family discussions, especially when explaining brain death, also has been emphasized as important in obtaining consent for organ donation (Rocheleau 2001). According to one study, 25 percent of those who refused to give consent did so because of dissatisfaction with how the request was made (Cleiren and Van Zoelen 2002). The way healthcare professionals in intensive care units (ICUs) communicate and interact with family significantly affects donation outcomes. Families who choose not to donate are more likely to say that a bond of trust was never established (Haddow 2004). Involving specially designated requestors {sometimes called "family communication coordinators"), who have received intensive training on how to make the request from the potential donor's family, leads to higher consent rates (Aldridge, Guy, and Roggenkamp 2003; Roth et al. 2003; Robbins et al. 2001; Linyear and Tartaglia 1999; Gortmaker et al. 1998). Donation requests made by transplant coordinators or physicians have been found to be more successful than requests made by nurses or social workers (Exley, White, and Martin 2002). When making the request, refuting the cons of donating (refutational information model) rather than presenting both sides (conventional information model) increases consent rates (Radecki and Jaccard 1997; Horton 1991).
Individual Characteristics of Donors and Families
General demographic characteristics are related...
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