Background
Methods
Data sources and searches
Selection criteria and process
Data extraction and quality assessment
Data synthesis and analysis
Results
Characteristics of included studies
Study, year, country [reference] | Study design | Intervention and setting | Population, n | Intervention(s) vs. control(s) | Outcome | Effect | p value | |||
---|---|---|---|---|---|---|---|---|---|---|
Intervention | Control | Intervention | Control | Additional group | ||||||
Adanir et al. 2014, Turkey [12] | RCT | Psychological support for relatives of patients at one general ICU | First-degree relatives of 100 ICU patients | First-degree relatives of 100 ICU patients | Psychological support vs. no psychological support | Consent rate if patient had become brain dead, % | 75 | 32 | < 0.0001 | |
Consent rate if patient died, % | 78 | 13.9 | < 0.0001 | |||||||
Beasley et al. 1997, USA [13] | UBA | A large-scale intervention for physicians, residents, nurses, social workers, chaplains and administrators in 50 hospitals in three OPO service areas | 369 potential donors | 422 potential donors | After vs. before intervention | Donor identification, % | 97.0 | 90.5 | 0.001 | |
Referral rate, % | 80.2 | 55.5 | 0.001 | |||||||
Donation requested, % | 85.6 | 69.0 | 0.001 | |||||||
Family consent rate, % | 52.2 | 50.9 | NS | |||||||
Donation rate, % | 42.5 | 32.9 | 0.005 | |||||||
Beigee et al. 2017, Iran [14] | UBA | More active identification of brain dead cases in hospitals (n = NR) affiliated to organ procurement units of Shahid Beheshti University of Medical Sciences | NR | NR | After vs. before intervention: from calling a couple of times per week to calling every day | Reported cases of brain death, n | 460 | 224 | NR | |
Number of confirmed cases of brain death, n | 306 | 180 | NR | |||||||
Number of cases transferred to the OPU, n | 188 | 125 | NR | |||||||
Actual number of donors, n | 165 | 115 | NR | |||||||
Family consent rate, % | 90% | 75% | < 0.001 | |||||||
Number of donated organs per each brain-dead case, n | 2.74 | 2.67 | NR | |||||||
Bires 1999, USA [15] | Cohort study | An 8-h designated requestor program implemented in one hospital;13 requestors were trained | 19 potential donors before, 20 after | 9 potential donors before, 15 after | Hospital with designated requestors vs. hospital with organ procurement coordinators | Consent rate before intervention, % | 58 | 66 | NR (1.000a) | |
Consent rate after intervention, % | 50 | 60 | NR (0.734a) | |||||||
Bleakley. 2010, UK [16] | UBA | Donor identification scheme and training of 170 staff members in four hospital sites | NR | NR | After vs. before intervention | Number of referrals, n | 121 | 4 | NR | |
Number of successful organ donors, n | 9 | 0 | NR | |||||||
Number of organs transplanted, n | 22 | 0 | NR | |||||||
Feest et al. 1990, UK [17] | UBA | Protocol to detect and transfer potential organ donors to the ICU for organ donation implemented in one hospital | 18 donors | 3 donors | After vs. before intervention | Donors derived outside ICU, n | 8 | 0 | NR | |
Donors from ICU, n | 10 | 3 | NR | |||||||
Possible donors where donation was not discussed, n | 4 | 8 | NR (0.005a: total number of donors from possible donors) | |||||||
Garside et al. 2012, UK [18] | UBA | An embedded specialist nurse in organ donation (SNOD) and utilization of a collaborative care pathway in one hospital | 160 ED deaths | 151 ED deaths | After vs. before intervention | Referral to organ donation team from ED, n | 26 | 3 | < 0.0001 | |
Patients proceeding to organ donation from ED, n | 2 | 0 | 1.0 | |||||||
Referral to organ donation team from ICU, n | 44 | 9 | NR | |||||||
Henderson et al. 1998, USA [19] | UBA | Educational campaign of emergency personnel in one hospital | 1995: 25 potential donors, 1996: 45 potential donors | 10 potential donors | One year after intervention (1995) vs. before intervention vs. 2 years after intervention (1996) | 1995 | 1994 | 1996 | 1995 vs. 1994 | |
Referral to OPA from ED, % of potential organ donors | 100 | 10 | 100 | < 0.0001 | ||||||
Organs procured from ED, n | 14 | 0 | 32 | NR | ||||||
Actual donors from ED, n | NR | 0 | 10 | NR | ||||||
Ismail et al. 2018, Netherlands [20] | Cohort study | A telephone-based advisory support by an experienced trained psychologist for requesters who are about to request for donation. | 141 requestors with intervention | 1563 requestors without intervention | Intervention vs. control | Consent or assent rate potential donors | 58% | 35% | < 0.001 | |
Consent or assent rate potential donors not registered in DR | 44% | 19% | < 0.001 | |||||||
Consent rate potential donors who leave decision to next of kin | 31% | 30% | > 0.99 | |||||||
Assent rate potential donors registered with permission in DR | 93% | 91% | 0.78 | |||||||
Jansen et al. 2011, Netherlands [21] | NRCT | Nurses were trained in communication about donation and have long-term contact with relatives of potential donors in one hospital | 1 hospital (66 relatives) | 2 different control hospitals (107 relatives vs. 99 relatives) | Hospital with trained donation practitioners (TDP) vs. control hospital vs. control hospital with hostesses | TDP | Control | Hostess | ||
Consent rate including consent in Donor Registry, % | 57.5 | 34.6 | 39.4 | 0.003 (TDP vs. control) | ||||||
0.022 (TDP vs. hostess) | ||||||||||
Consent rate excluding consent in Donor Registry, % | 45.1 | 21.7 | 26.3 | 0.004 (TDP vs. control) | ||||||
0.026 (TDP vs. hostess) | ||||||||||
Consent rate organ donation, % | 60.0 | 32.7 | < 0.022 | |||||||
Krekula et al. 2014, Sweden [22] | CBA | Donation specialist nurses (DOSSes) who support the local team with the medical care of eligible donors; 7 DOSSes were appointed in a large urban county | 96 eligible donors with DOSS participation | 15 eligible donors without DOSS participation, 59 before DOSS service | DOSS participated vs. DOSS did not participate vs. before intervention | DOSS | No DOSS | Before | DOSS vs. no DOSS | |
Donation rate, % | 74 | 20 | 37 | 0.001 | ||||||
Reason for not becoming actual donors: family vetoes, % | 14 | 60 | 34 | 0.001 | ||||||
Reason for not becoming actual donors: non-willingness deceased, % | 7 | 20 | 5 | NR | ||||||
Lenzi et al. 2014, Brazil [23] | Cohort study | Requesting donation by OPO professional (intervention), In-Hospital Coordinator (IHC) or ICU physician in Rio de Janeiro, Brazil | 167 (2011) and 248 (2012) OPO | 63 (2011) and 55 (2012) ICU; 55 (2011) and 108 (2012) IHC | OPO vs. ICU (not trained) vs. IHC | OPO | ICU | IHC | ||
Consent rate 2011, % | 63.5 | 12.7 | 41.8 53.7 | NR (< 0.001a) NR (< 0.001a) | ||||||
Consent rate 2012, % | 64.5 | 20.4 | ||||||||
Linyear et al. 1999, USA [24] | UBA | Implementation of a systematic hospital-based program at Virginia Commonwealth University | Post 1997: 27 potential donors Post 1998: 20 potential donors | 42 potential donors | After intervention 1997 vs. before intervention vs. after intervention 1998 | After 1997 | Before | After 1998 | ||
Referral rate, % | 93 | 95 | 90 | NR (0.734a) | ||||||
Approach rate, % | 93 | 88 | 90 | NR (0.833a) | ||||||
Consent rate, % | 44 | 49 | 72 | NR (0.153a) | ||||||
Donation rate, % | 26 | 36 | 50 | NR (0.235a) | ||||||
Manyalich et al. 2012, international [25] | UBA | Training program implemented in 220 hospitals in 16 countries | 1101 declared brain deaths | 784 declared brain deaths | After vs. before intervention | Utilized donors identified, mean ± SD (range) | 20.0 ± 17.1 (1–78) | 15.7 ± 14.3 (2–69) | 0.014 | |
Organs recovered, mean ± (range) | 59.3 ± 52.2 (2–247) | 49.7 ± 48.6 (0–228) | 0.044 | |||||||
Mulvania et al. 2014, Australia [26] | UBA | Customized, self-sustaining training program area in Australia | NR | NR | 3 years during implementation (2011–2013). Pilot program started October 2011. | 2013 | 2011 | 2012 | ||
Number of deceased brain dead donors, n | 391 | 337 | 354 | NR | ||||||
Request rate, % | 96 | 94 | 92 | |||||||
Consent rate, % | 62 | 59 | 61 | NR NR NR | ||||||
Conversion rate, % | 53 | 49 | 51 | |||||||
Sandiumenge et al. 2018, Spain [27] | UBA | An instant messaging application (WhatsApp@) was implemented in order to refer potential donors to the DC | 74 potential donors outside ICU | 40 potential donors outside ICU | After vs. before intervention | After | Before | |||
Referral of possible donors to DC from outside ICU | 62% | 32% | < 0.05 | |||||||
Proportion donors outside ICU from BD donors in hospital | 29% | 13% | < 0.05 | |||||||
Siminoff et al. 2009, USA [28] | UBA | Training program ‘Communicating Effectively About Donation’ in 17 hospitals | 325 eligible donors | 134 eligible donors | After vs. before intervention | Consent rate, % | 55.5 | 46.3 | 0.07 | |
Time-sensitive referrals, n (% of eligible donors) | 281 (86.5) | 116 (86.6) | 0.97 | |||||||
Siminoff et al. 2015, USA [29] | RCT | Online training program ‘Communicating Effectively about Donation’ in 9 OPOs. CEaD1: theoretical. CEaD2: theoretical and practical (Table 1). | CEaD1: 558 requests, CEaD2: 368 requests | 677 requests | After CEaD1 vs. before intervention vs. After CEaD2 | CEaD1 | Before | CEaD2 | CEaD1 vs. CEaD2 | |
Consent rate, % | 83 | 84 | 86 | NS | ||||||
Consent rate novice, % | 80 | 78 | 89 | 0.03 | ||||||
Consent rate midlevel, % | 76 | 81 | 88 | 0.004 | ||||||
Consent rate senior, % | 92 | 89 | 83 | 0.02 | ||||||
Stark et al. 1994, USA [30] | UBA | Nurse requestor educational program in one hospital; 25 requestors were trained | 11 potential donors | 15 potential donors | After (1993) vs. before (1991) intervention | Referrals/requests, n (%) | 11 (100) | 10 (67) | NR (0.053a) | |
Consent/donations, n (%) | 8 (73) | 4 (27) | NR (0.198a) | |||||||
Von Pohle et al. 1996, USA [31] | Cohort study | Decoupled presentation of the option of organ donation by OPO representative in one hospital | 34 potential donors | 47 potential donors | After vs. before intervention | Donation rate, % | 59 | 38 | < 0.05 | |
Young et al. 2009, UK [32] | RCT | Collaborative requesting by potential donor’s clinician and donor transplant coordinator in 79 ICUs in the UK | 100 relatives | 101 relatives | Collaborative requesting vs. routine requesting by the clinical team alone | Consent rate intention to treat, % | 57 | 62 | 0.53 | |
Consent rate per protocol, % | 67 | 60 | 0.33 | |||||||
Zier et al. 2017, USA [33] | UBA | Implementation of an electronic decision support system to identify patients who meet OPO notification criteria in one hospital | 30 patients meeting trigger criteria | 58 patients meeting trigger criteria | After vs. before intervention | Time to referral, hours (range) | 1.7 h (0–23.2 h) | 30.2 h (0–288.5 h) | 0.015 | |
Donor conversion rate, % | 9/10 = 90% | 6/12 = 50% | 0.074 | |||||||
Proportions of notifications occurring ≤ 1 h, % | 70% | 36% | 0.003 | |||||||
Median time to notification, hours | < 0.01 h | 3.5 h | 0.001 | |||||||
Total organ donors/critical care death, % | 11/24 = 46% | 7/57 = 12% | 0.002 |
Study [reference] | Intervention | Relevant actions | Key players | Classification | Significant effects | ||
---|---|---|---|---|---|---|---|
Identification and referral | Education | Support of relatives | |||||
Adanir et al. [12] | Psychological support for relatives | The relatives in the intervention group attended interviews every 2 days with a psychologist if they wanted to. At least 3 therapeutic interviews were completed. | Psychologists | X | Yes | ||
Beasley et al. [13] | Hospital adapted interventions | Monitoring of organ donation, implementation strategy, introduction of recommended practices, development of multidisciplinary team. | Physicians, residents, nurses, social workers, chaplains and administrators | X | Yes | ||
Beigee et al. [14] | Donor identification | The procurement centers call every day to ICUs, emergency departments, coronary care unit, neurosurgery and supervisors of medical centers and trauma centers. | Trained personnel from organ procurement centers | X | NR | ||
Bires [15] | Training of requestors | An 8-h designated requestor program was conducted by the OPO. | Requestors | X | NR (noa) | ||
Bleakley [16] | Donor identification | Implementation of a donor identification scheme. | Staff members | X | NR | ||
Feest et al. [17] | Donor identification | The protocol describes the criteria of identification of potential organ donors and enables transfer of patients to ICU for ventilatory support until organ retrieval can be arranged. | Physicians, transplant team, representatives of nurses from medical wards, ICU | X | NR (yesa) | ||
Garside et al. [18] | Specialist nurse in organ donation (SNOD) and collaborative care pathway | The role of the SNOD involves close liaison with ICU and ED staff at all levels, ensuring a multidisciplinary collaborative approach to the early identification and management of potential donors. A collaborative care pathway was introduced to identify clinical triggers and facilitate the referral of potential organ donors. | SNODs and ICU and ED staff | X | X | Yes | |
Henderson et al. [19] | Training of emergency personnel | The OPO educated the emergency personnel on the process of identifying potential donors, and the need for early OPO referral. The OPO also visits the ED every 2 to 3 months to reeducate the staff. | Emergency personnel | X | X | Yes | |
Ismail et al. [20] | Support by a CaD-trained psychologist for requesters | The Communication about Donation Telephone Advice by Psychologist (CaD-TAP) intervention was developed. The CaD-TAP intervention allows the requester to get general practical advice on effective communication from a CaD-trained psychologist shortly before the actual donation request. | Requesters | X | Yes | ||
Jansen et al. [21] | Training of nurses | Nurses completed the training ‘Communication about donation’. The trained donation practitioners are always available, 24 h a day, and guide the relatives through the donation decision process. | Nurses | X | Yes | ||
Krekula et al. [22] | Training of nurses | The donation specialist nurse (DOSS) on call supports the local team with the medical care of the donors and with the actual donation request, primarily together with the local physician. The DOSSes also promote adherence to standard routines concerning organ donation and take responsibility for the follow-up with DR at their local hospitals. | Nurses | X | Yes | ||
Lenzi et al. [23] | Donation request by trained professional | Performances in obtaining informed consent from potential donors’ families were compared according to the type of healthcare professional conducting the interviews: OPO, In-hospital coordinator or ICU physician (not trained). | OPO, in-hospital coordinators, ICU physicians | X | NR (yesa) | ||
Linyear et al. [24] | Family communication protocol | A standard family communication protocol was developed to ensure consistent identification of all patients with devastating neurological insults who might progress to brain death, optimal family communication and support, and a request for organ donation in accordance with best-demonstrated practices. | Nurses and physicians from the ICUs, as well as hospital administrators, chaplains, and LifeNet representatives | X | X | NR (noa) | |
Manyalich et al. [25] | Training of healthcare professionals | Three educational initiatives were designed and implemented: 1) essentials in organ donation 2) professional training for junior transplant coordinators and 3) organ donation quality management. A public website, a private virtual platform and an e-learning campus were used as communication tools. | Professionals in ICUs, postoperative recovery, emergency rooms, etc. (in areas where organ donors can be actively detected) | X | Yes | ||
Mulvania et al. [26] | Training of healthcare professionals | A customized, self-sustaining training program. Two 1-day pilot training sessions were provided to 45 Australian donation leaders. Also, 26 2-day family donation conversation workshops were held in 8 cities (646 participants). | Professionals from the Australian DonateLife Network, ICU, and emergency specialists | X | NR | ||
Sandiumenge et al. [27] | Donor identification and referral | Ninety percent of the specialists playing a key role in the management of possible donors outside the ICU were voluntarily included in a virtual collaborative group using an instant messaging application (WhatsApp@) in order to refer to the DC all patients presenting with GCS < 9 and who fulfilled any of the established by consensus criteria. | Professionals playing a key role in the management of possible donors outside the ICU | X | Yes | ||
Siminoff et al. [28] | Training of healthcare professionals | The training was divided into a day-long interactive group workshop, taught by the principal investigator and then individual skills-based simulated donation scenarios with feedback. | OPO staff members | X | No | ||
Siminoff et al. [29] | Online training of healthcare professionals | Two versions were developed: 1) CEaD1: requesters viewed a series of 4 donation scenarios of increasing difficulty embedded within a web-based tutorial. An accompanying workbook detailed the specific skills needed to effectively initiate request, etc. 2) CEaD2: requesters received the same training as CEaD1, together with live practice and feedback using simulated family scenarios. | Requesters | X | Yes | ||
Stark et al. [30] | Training of nurse requestors | The education program was designed to encompass four concepts: awareness, recognition, offering the option of donation and bereavement. | Nurse requesters | X | X | NR (noa) | |
von Pohle [31] | Donation request by OPO representative | Institution started working with a dedicated representatives from the local OPO who uses decoupling routinely. They spend whatever amount of time is needed with the family to explain the process of donation. | OPO representatives | X | Yes | ||
Young et al. [32] | Collaborative requesting | Collaborative requesting by clinician and donor transplant coordinator. | Clinician and transplant coordinator | X | No | ||
Zier et al. [33] | Donor identification | An Electronic Decision Support system was developed to identify patients who meet OPO notification criteria impending brain death. When the algorithm detects a patient who fulfills notification criteria, a system-generated email is sent directly to the OPO. | OPO | X | Yes |