The Organ Referral Characterisation Database (ORCHARD) study was established in collaboration with the NSW Organ and Tissue Donation Service (OTDS), and the NSW Transplant Advisory Committee in 2010 to describe trends in organ donor referrals. This study is a retrospective clinical audit of all patients referred to the OTDS for deceased organ donation in NSW. ORCHARD is on-going. This work was supported by the NSW Ministry of Health.
Using these data the CODE team have been able to describe trends in the organ donor referral pathway and outcomes over time, including characterising the people who were referred to be considered for organ donation near the time of their death but did not go on to become donors. Often it was their families who declined their organs be donated; understanding what factors are at play when families decline may help us provide more appropriate support to them at the time they are making their decisions. On many occasions, people were declined as donors by the clinical team over concerns about their medical suitability. These safety concerns are either because the potential donor had chronic health conditions which affect the organs they could donate, or often because of concern that they might transmit infection or cancer to the transplant recipients receiving their organs. Often these decisions err on the side of caution, in order to make sure no harm is done. It may be that sometimes the decisions are over-cautious, and some donors who could have safely donated, are being declined – often because the information that could help the decision-makers, is not available to them at the crucial time. By characterising the people who didn’t donate, as well as those who did donate, the CODE team hope to demonstrate wherein the decision-making process, more evidence and support might help the right decisions are made at the right time.