Donation Physician Specialists and Missed Organ Donation Opportunities.

Importance: Donation physicians (DPs) are usually critical care specialists whose responsibilities may include assessment of donation eligibility, care of potential donors, death determination, education, and advocacy. While DP programs have been implemented in some countries with the aim of optimizing the organ donation process, there are few studies evaluating their effectiveness. Objective: To assess the association of a DP program with key performance metrics. Design, Setting, and Participants: This cohort study used interrupted time series analysis to compare baseline data from intensive care units and emergency departments in a Canadian province (December 2019 to February 2020 and March 2021 to May 2021) with data following the initial 3 years of a DP program (July 2021 to June 2024). Donation data included consecutive deceased critically ill patients with various forms of brain injury who received mechanical ventilation in the last 12 hours of life. Exposure: Implementation of a province-wide DP program coupled with regular audit and feedback aimed at identifying and minimizing missed donation opportunities. Main Outcomes and Measures: Missed organ donation opportunities, defined as occurring when families of eligible potential donors were not given the option of donation. Secondary outcomes included appropriate notification of the provincial donation organization, donors per million population, and median number of organs transplanted per donor. Results: Over 42 months, there were 1072 eligible potential donors, including 635 (59%) following death by neurologic criteria and 437 (41%) following death by circulatory criteria. The median (IQR) age was 44.6 (30.8-58.3) years, 662 (62%) were male, and the most common cause of death was hypoxic-ischemic brain injury. During the initial 36 months of the DP program, 129 of 942 (14%) eligible potential donors were missed, compared with 43 of 123 (33%) during 6 months of baseline data (P < .001). The monthly proportion of missed cases decreased by 10.9% (95% CI, -22.0% to 0.3%; P = .06) immediately following the start of the program and then declined -0.7% (95% CI, -0.9% to -0.5%; P < .001) per month. Appropriate notification of the provincial organ donation organization increased 0.9% (95% CI, 0.6% to 1.3%, P < .001) per month. The annual donation rate increased from 14.0 to 23.7 donors per million. The median (IQR) number of organs transplanted per donor did not change (4 [3-5]; P = .69). Missed opportunities occurred in 3% of eligible potential donors when the most responsible physician was a DP and 17% when it was not (P < .001). Conclusions: In this cohort study of consecutive eligible potential organ donors, implementation of a novel DP program was associated with a sustained reduction in missed organ donation opportunities, increased referrals, and a higher deceased donation rate.