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Transplant Statistics: Annual Report
APPENDIX F
OPTN Education, Donation, and Data Activities
The Professional Services Department (PSD) at UNOS develops materials and coordinates projects related to educating health professionals about transplantation and organ donation. Along with the Research Department, the PSD also responds to requests for transplantation-related information from patients awaiting transplantation and from the general public. Under the current OPTN contract, the PSD develops and coordinates the following types of education, donation, and data activities:
This appendix will provide a brief description of these activities.
Over the last year, the PSD has focused on three educational projects:
In 1999, under the direction of the Critical Care Advisory Council, UNOS coordinated the development of a Critical Pathway for the Organ Donor© and conducted a pilot study to determine its effectiveness in enhancing donation outcomes. Ten organ procurement organizations, working collaboratively with staff in 88 critical care units, formally implemented the critical pathway in those units during a 4 month period. Staff from participating units agreed to implement the critical pathway for every donor that was identified during the study period; in all, 130 donors were managed under the critical pathway guidelines. Retrospective data were collected from these units for the same 4 month period during the previous year, yielding 140 donors. The data from the two cohorts were compared and differences were tested for statistical significance.
For those donors that were managed under the critical pathway, there was a significant increase (p<0.03) in donor management time, with an increase of 8.5% over the non-critical pathway donor group. There was also a significant increase (p<0.01) in the number of organs recovered per donor. The number of organs recovered increased from 3.8 to 4.2 organs per donor, a 10.3% increase. Additionally, there was a significant increase (p<0.03) in the number of organs transplanted per donor. The number of organs transplanted per donor increased 11.3%, from 3.2 organs per donor in the non-critical pathway group to 3.6 among critical pathway donors.
Over the past 5 years in the United States, the number of organs recovered per donor has steadily decreased by 5%, and the number of organs transplanted per donor has remained static. In view of that trend, the increases in organs recovered and transplanted per donor following the implementation of the critical pathway are even more remarkable. Additional benefits, such as the creation of a collaborative care environment in the units, also were reported. The Critical Pathway for the Organ Donor© could play a crucial role in increasing the number of organs available for transplant and decreasing the number of deaths to those awaiting transplantation.
NHBD Advisory Council. It has been estimated that there are at least 1,000 controlled potential NHB donors each year. Less than 10% of these patients and their families are being reached. The results of a 1997 study by the Institute of Medicine, at the request of the Department of Health and Human Services (HHS), support the recovery of organs from NHB donors and the study recommends national policy to address issues of concern.
The NHBD Advisory Council will direct a national focus group study of the transplant community and other healthcare professionals who care for potential NHB donors. The study will assess the current level of awareness and knowledge of NHBD, the attitudes and practices of practitioners, as well as any actual or perceived barriers to NHBD. Some of the organizations participating in the study include the American Academy of Neurology, the American College of Surgeons' Committee on Trauma, the American Society of Transplant Surgeons, the Association of Organ Procurement Organizations, and the Emergency Nurses Association. The information obtained from the focus groups will be used to develop OPTN/UNOS policy and to direct future national education initiatives.
Critical Care Advisory Council. This advisory council was assembled to direct a NHBD project for critical care staff. Its focus is the development of a critical pathway for the non-heartbeating donor, the dissemination of the pathway to critical care staff across the country, and to provide a standardized protocol for donor management. Additionally, a packet of resource materials will be developed to assist OPOs who wish to implement non-heartbeating donor protocols.
The Critical Care Advisory Council is composed of representatives from the Society of Critical Care Medicine, the American Association of Critical Care Nurses, the American Association of Neuroscience Nurses, the National Medical Association, the North American Transplant Coordinators Organization, the Association of Organ Procurement Organizations, and the American Society of Transplant Surgeons. PSD staff will coordinate and support the work of the council.
Operating Room Staff Advisory Council. This working group will develop guidelines regarding non-heartbeating donation in the operating room, identify appropriate educational opportunities and materials for operating room staff, and pursue the development of NHBD standards of practice for each operating room healthcare specialty.
The Operating Room Staff Advisory Council is made up of representatives from the American Association of Nurse Anesthetists, the American Medical Association, the American Society of Anesthesiologists, the Association of Perioperative Registered Nurses, the Association of Organ Procurement Organizations, the Association of Surgical Technologists, the National Medical Association, and the North American Transplant Coordinators Organization. PSD staff will coordinate and support the work of the council.
This study was developed to evaluate the effectiveness of the Nursing School Curriculum Project, or N-STAT, developed after a 1993 survey showed that there was little, if any, donation and transplantation-related curriculum in place at nursing schools across the country. In 2000, the PSD repeated the 1993 survey to determine the amount and type of donation and transplantation information currently in place within nursing school curricula, and to compare these results with those from the 1993 study. The project is still underway, though preliminary results appear to indicate an increased diversity of transplantation-related curricula and a positive change in faculty perceptions regarding donation and transplantation.
The PSD, working with the Medical Examiners and Coroners Task Force, revised the resource booklet, Death Investigation and Donor & Tissue Donation. The booklet provides medical examiners and coroners with relevant legislation, protocols, and projects relating to organ and tissue donation. The booklet is currently available on the OPTN web site and there are plans to publish a printed version.
In 2000, the PSD updated the brochure, What Every Patient Needs to Know, a resource guide for patients who are waiting for a transplant. The booklet contains information about the OPTN, the transplant waiting list, frequently asked questions, financial information about the cost of transplantation, information about the posttransplant period, resources for transplant patients, and promoting organ donation.
The PSD actively works with the transplant community to develop new professional educational initiatives. The following committees and working groups have helped and continue to shape the work of the PSD.
Patient Access Task Force. This task force sought to improve patient access to transplantation through a review of OPTN activities. Among the issues the task force discussed were improving communication with insurance companies, educating medical staff about referring patients for transplant, and caring for the posttransplant patient. The task force made recommendations to the Board of Directors and, having completed its work, disbanded in June 2001.
Primary Care Professional Advisory Council. This group is developing an initiative to educate primary care professionals about organ donation and transplantation. It held its first meeting in May 2001.
Hospital Administrators Initiative. This project will educate hospital administrators about donation and transplantation. Its specific focus will be on the Conditions of Participation, that is, legislation that mandates referral of all hospital deaths to an OPO. The advisory council is being formulated at this time.
The PSD also supports several OPTN committees including the Ethics Committee, the Organ Availability Committee, the OPO Committee, and the Patient Affairs Committee. Policy-related activities of these and other OPTN committees are described in Appendix D.
The PSD provides patient information services to patients and the general public. Table F-1 shows the number and type of requests fulfilled in 2000.
The Research Department provides data to researchers and transplant professionals, the Federal government, the media, and the public. Table F-2 shows the number of completed requests by requestor for the last 10 years. The number of completed requests increased by 6% between 1999 and 2000.
In addition to the patient information and data request systems, UNOS also maintains the National Transplantation Resource Center, which offers a comprehensive collection of literature relating to transplantation.
National Exhibit Consortium (NEC). UNOS, along with eight other transplant-related organizations, make up the NEC. Per the OPTN contract, the NEC focuses on meetings that target leaders of minority communities and on organizations seeking to enhance organ donation. In 2000 and 2001, the NEC exhibited at the following meetings:
Professional Services Department (PSD). In 2000 and 2001, the PSD exhibited educational materials at several meetings, many of which appear on the NEC list. Other meetings include:
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