Joining efforts in tackling the organ shortage: the Donor Action experience.

1. Donor Action takes a systematic approach towards achieving quality assurance in the whole donation process. It is designed to give hospitals participation and ownership of donation practices that can be tailored to meet identified needs in critical care units (CCUs). The program has been successfully introduced in 18 countries and in over 250 CCUs in North and South America, Europe and Asia. 2. Aggregated data collected in 162 CCUs in 10 countries showed significant losses of potential donors along the donation pathway. The major factor impacting on converting medically suitable cases with signs of brain death into potential donors was the willingness of CCU staff to formally diagnose brain death. Major reasons for non-donation in BD-diagnosed cases were non-referral (26.5%), family refusal (20%), or no approach of next-of-kin (13.2%). 3. Pre-intervention data show that professional training, clear role definitions, teamwork, comprehensive guidelines and consistent protocols dealing with all donation-related tasks in the CCU setting are critical to achieve optimal donation rates. 4. Implementation of these improvement measures in 10 countries have shown an immediate overall increase of donation rates of 59% after 1 year and a sustained, even growing effect on referral and donation rates in those countries with sufficient follow-up, proving a permanent impact of DA's methodology. 5. As a health-economic evaluation, based on the German case, shows that the implementation cost of the program in pilot centers was far below the investment thresholds. Donor Action is more cost-effective than other publicly reimbursed medical interventions. Incorporating health economic consequences of other cadaveric organ transplants into the analysis could even further improve the cost-benefit ratio of Donor Action compared with current organ donation practices.