System of donor hospital transplant coordinators maintained and financed by national transplant organization improves donation rates, but it is effective only in a half of hospitals

JarosÅ‚aw CzerwiÅ„ski^1,2, Teresa Danek², Adam Parulski³, Monika Trujnara⁴, Roman Danielewicz^1,2

¹Dep. of Surgical and Transplant Nursing, Medical University of Warsaw. Poltransplant, Warsaw, Poland, ²Polish Transplant Coordinating Center, Poltransplant, Warsaw, Poland, ³Dep. of Cardiosurgery, The Cardinal Stefan WyszyÅ„ski Institute of Cardiology, Warsaw, Poland, ⁴Dep. of Anaesthesiology and Intensive Care, MiÄ™dzyleski Specialistic Hospital, warsaw, Poland

Coordinators in the number of 218 trained professionals (134 doctors and 84 nurses) are employed by Poltransplant in 200 hospitals (ca 50% of total number of hospitals with potential of donation). This resulted, after 21 months of work, compared to 21 month period prior to their employment in changes of the following hospital donation indicators:

• increasing the number of reported potential deceased donors by 27%

• Increasing the number of actual deceased organ donors by 24%

• increasing the percentage of multiorgan donation from 54% to 56%

• increasing the number of transplanted organs by 20%

• increasing the percentage of family refusals to donation from 8.5% to 9.3%

• reducing the rate of utilized organs per actual donor from 2.65 to 2.57

The desired effect of the employment of hospital donor coordinators to improve organ procurement rates was reached in 102 (51%) hospitals; in this group there were hospitals where there was no pre-employment donations and they took place after the employment, where the number of donations has increased or remained the previous level. In 98 (49%) hospitals had no procurements before or after the employment of coordinators, were before hiring them, but there was no after or the number of actual donors has decreased.
Pronounced effect was observed in hospitals:

• located in regions with low baseline rate of donation (59%)

• academic hospitals (63%) and multi-profile hospitals in large cities (77%)

• hospitals, where a team of two coordinators was set up (67%)

• hospitals for adults (52%)

• hospitals, where doctors were assigned coordinators (55%)

The annual formal analysis of activity of donor hospital coordinators gives to national transplant organization a rational basis for their employment taking into account the characteristics of hospitals and the characteristics of hospital coordination team