Korean J Transplant.  2020 Dec;34(4):219-230. 10.4285/kjt.20.0040.

Causes of donation failure and improvement measures analyzed based on data from domestic deceased donors in 2019

• Cho WH

• KMID: 2510254
• DOI: http://doi.org/10.4285/kjt.20.0040

Abstract

In 2019, 1,630 organs were recovered from 450 brain death donors nationwide and were transplanted into 1,612 transplant recipients. However, considering that the number of potential brain-dead linked to the Korea Organ Donation Agency (KODA) information center was 2,484, only 18.1% of the linked brain-dead donated successfully. Of the 1,606 people who were available for family interviews, 67.0% refused to donate, so their cause analysis and countermeasures are needed. In particular, 203 reported cases died during the early period of donor evaluation, so we need a special concern on these cases. After consent, 67 cases failed to donate due to death or poor organ condition, and this raises the question of the possibility of shortening brain death management time. The average time interval from the first investigation to the completion of the second investigation (11.5 hours), until obtaining a flat electroencephalogram (5.3 hours) and conclusion of the brain death committee is 5.9 hours. Reducing unnecessary brain death management time is expected to improve the quality of organs and increase the number of organs to be recovered. Therefore, efforts to accurately identify and report potential brain death, and efforts to reduce the time spent in confirming brain death together with improving awareness of organ donation in people across the country are necessary to increase the number of deceased donors even in the current brain death management system. Implementation of donation after circulatory death for mortality case during the donor management is also urgent.

Keyword

Brain death; Donor; Donor screening; Deceased donor

Figure

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  Fig. 1 Annual number of deceased donors and recipients from deceased donors. Important indicators of deceased donor in 2019: donor age, 66 day–86 yr (average, 47.0 yr); donor sex ratio (M:F), 2:1; brain death donor per million population, 8.70; number of recovered organs per donor, 3.58; recovered but not transplanted organs, 0.7%. Data from Korea Organ Donation Agency annual report 2019 [1].

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  Fig. 2 Recovered organs per deceased donor by age group in 2019. Data from Korea Organ Donation Agency annual report 2019 [1].

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  Fig. 3 Change of causes of brain death in 2019. Data from Korea Organ Donation Agency annual report 2019 [1].

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  Fig. 4 Number of donors managed by Korea Organ Donation Agency (KODA) and Hospital-Based Organ Procurement Organization (HOPO) [1].

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  Fig. 5 Donation process of brain-dead organ donors and time spent on each step. EEG, electroencephalogram. Data from Korea Organ Donation Agency annual report 2019 [1].

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  Fig. 6 Mortality rate per 100,000 population by death causes. DCD, donation after circulatory death. Data from 2019 report of Korea National Statistical Office [3].

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  Fig. 7 Potential brain death reported to Korea Organ Donation Agency and actual organ donor per million population (pmp) of each local government. Data from Korea Organ Donation Agency annual report 2019 [1].

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  Fig. 8 Cumulative number of applicants for advanced medical directives and actual suspension of life-sustaining treatment. Data from National Agency for Management of Life-Sustaining Treatment [6].

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  Fig. 9 Protocol to manage end of life patients. Revised Uniform Anatomical Gift Act (UAGA). AD, advance health care directive; SNOD, specialist nurse in organ donation. Modified from Verheijde et al. [7].

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  Fig. 10 Consent rate by age group of deceased donors. Data from Korea Organ Donation Agency annual report 2019 [1].

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