ORCHARD – the Organ Referral CHARacterisation Database

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.

Research Publications

2020

Mata, Nicole L. De La; Clayton, Philip A.; Kelly, Patrick J.; McDonald, Stephen; Chadban, Steven; Polkinghorne, Kevan R.; Webster, Angela C.

Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage Journal Article

In: vol. 6, no. 3, 2020, ISSN: 2373-8731.

Abstract | Links | BibTeX

@article{DeLaMata2020,

title = {Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage},

author = {Nicole L. De La Mata and Philip A. Clayton and Patrick J. Kelly and Stephen McDonald and Steven Chadban and Kevan R. Polkinghorne and Angela C. Webster},

doi = {10.1097/txd.0000000000000975},

issn = {2373-8731},

year  = {2020},

date = {2020-00-00},

urldate = {2020-00-00},

volume = {6},

number = {3},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {<jats:sec>

            <jats:title>Background.</jats:title>

            <jats:p>Living kidney donors are a highly selected healthy population expected to have high survival postdonation, but mortality studies are limited. Our study aimed to compare mortality in living kidney donors with the general population in Australia and New Zealand, hypothesizing that donor survival would exceed average survival.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Methods.</jats:title>

            <jats:p>All living kidney donors in Australia, 2004–2013, and New Zealand, 2004–2012, from the Australian and New Zealand Living Kidney Donor Registry were included. We ascertained primary cause of death from data linkage with national death registers. Standardized mortality ratios and relative survival were estimated, matching on age, sex, calendar year, and country.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Results.</jats:title>

            <jats:p>Among 3253 living kidney donors, there were 32 deaths over 20 331 person-years, with median follow-up 6.2 years [interquartile range: 3.9–8.4]. Only 25 donors had diabetes-fasting blood sugar level predonation, of which 3 had impaired glucose tolerance. At discharge, the median creatinine was 108 µmol/L and estimated glomerular filtration rate was 58 mL/min/1.72 m<jats:sup>2</jats:sup>. Four deaths occurred in the first year: 2 from immediate complications of donation, and 2 from unrelated accidental causes. The leading cause of death was cancer (n = 16). The crude mortality rate was 157 (95% confidence interval [CI], 111-222)/100 000 person-y, and the standardized mortality ratio was 0.33 (95% CI, 0.24-0.47). The 5-year cumulative relative survival was 1.019 (95% CI, 1.014-1.021), confirming that the survival probability in living kidney donors was 2% higher relative to the general population.</jats:p>

          </jats:sec>

          <jats:sec>

            <jats:title>Conclusions.</jats:title>

            <jats:p>As expected, mortality in living kidney donors was substantially lower than the general population and is reassuring for potential donor counseling. The Living Donor Registry only captured a third of the deaths, highlighting the benefit of data linkage to national death registries in the long-term follow-up of living kidney donors.</jats:p>

          </jats:sec>},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Background.
Living kidney donors are a highly selected healthy population expected to have high survival postdonation, but mortality studies are limited. Our study aimed to compare mortality in living kidney donors with the general population in Australia and New Zealand, hypothesizing that donor survival would exceed average survival.

Methods.
All living kidney donors in Australia, 2004–2013, and New Zealand, 2004–2012, from the Australian and New Zealand Living Kidney Donor Registry were included. We ascertained primary cause of death from data linkage with national death registers. Standardized mortality ratios and relative survival were estimated, matching on age, sex, calendar year, and country.

Results.
Among 3253 living kidney donors, there were 32 deaths over 20 331 person-years, with median follow-up 6.2 years [interquartile range: 3.9–8.4]. Only 25 donors had diabetes-fasting blood sugar level predonation, of which 3 had impaired glucose tolerance. At discharge, the median creatinine was 108 µmol/L and estimated glomerular filtration rate was 58 mL/min/1.72 m2. Four deaths occurred in the first year: 2 from immediate complications of donation, and 2 from unrelated accidental causes. The leading cause of death was cancer (n = 16). The crude mortality rate was 157 (95% confidence interval [CI], 111-222)/100 000 person-y, and the standardized mortality ratio was 0.33 (95% CI, 0.24-0.47). The 5-year cumulative relative survival was 1.019 (95% CI, 1.014-1.021), confirming that the survival probability in living kidney donors was 2% higher relative to the general population.

Conclusions.
As expected, mortality in living kidney donors was substantially lower than the general population and is reassuring for potential donor counseling. The Living Donor Registry only captured a third of the deaths, highlighting the benefit of data linkage to national death registries in the long-term follow-up of living kidney donors.

2019

Hedley, James A.; Chang, Nicholas; Kelly, Patrick J.; Rosales, Brenda M.; Wyburn, Kate; O'Leary, Michael; Cavazzoni, Elena; Webster, Angela C.

Weekend effect: analysing temporal trends in solid organ donation Journal Article

In: ANZ Journal of Surgery, vol. 89, no. 9, pp. 1068–1074, 2019, ISSN: 1445-2197.

Abstract | Links | BibTeX

@article{Hedley2019,

title = {Weekend effect: analysing temporal trends in solid organ donation},

author = {James A. Hedley and Nicholas Chang and Patrick J. Kelly and Brenda M. Rosales and Kate Wyburn and Michael O'Leary and Elena Cavazzoni and Angela C. Webster},

doi = {10.1111/ans.15015},

issn = {1445-2197},

year  = {2019},

date = {2019-09-00},

urldate = {2019-09-00},

journal = {ANZ Journal of Surgery},

volume = {89},

number = {9},

pages = {1068--1074},

publisher = {Wiley},

abstract = {<jats:sec><jats:title>Background</jats:title><jats:p>Research suggests patients treated over weekends experience poorer outcomes. Only one US‐based study explored this weekend effect in organ donation, specifically the kidney discard rate. In Australia potential donors are referred to a donation service, and donation proceeds if family consent is granted and the donor is deemed medically suitable to donate. Organ procurement occurs when utilization is almost certain hence discard rates are much lower than in the USA. We aimed to characterize the effect of weekend referral on organ donation in Australia.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We retrospectively reviewed all New South Wales Organ and Tissue Donation Service logs from 2010 to 2016. Our primary outcome was progression to organ procurement, and secondary outcomes were family consent and meeting medical suitability thresholds. We used logistic regression with random effects adjusting for clustering of referral hospitals.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 3496 potential donors referred for consideration, 694 (20%) progressed to organ procurement. There were fewer referrals on weekends (average 415 versus 588 for weekdays). However, donation rates were no lower for weekend compared to weekday referrals (adjusted OR 1.17; 95% CI 0.95, 1.44). Family consent (adjusted OR 1.20; 95% CI 1.00, 1.44) and medical suitability (adjusted OR 1.15; 95% CI 0.96, 1.38) were not lower for weekend compared to weekday referrals. Similar results were found for all sensitivity analyses conducted.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In Australia, the donation pathway operates consistently throughout the week, with donation no less likely to proceed on weekends and holidays. This finding contrasts with findings in the USA.</jats:p></jats:sec>},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Thomson, Imogen K.; Rosales, Brenda M.; Kelly, Patrick J.; Wyburn, Kate; Waller, Karen M. J.; Hirsch, Daniel; O’Leary, Michael J.; Webster, Angela C.

Epidemiology and Comorbidity Burden of Organ Donor Referrals in Australia: Cohort Study 2010–2015 Journal Article

In: vol. 5, no. 11, 2019, ISSN: 2373-8731.

Abstract | Links | BibTeX

@article{Thomson2019,

title = {Epidemiology and Comorbidity Burden of Organ Donor Referrals in Australia: Cohort Study 2010–2015},

author = {Imogen K. Thomson and Brenda M. Rosales and Patrick J. Kelly and Kate Wyburn and Karen M.J. Waller and Daniel Hirsch and Michael J. O’Leary and Angela C. Webster},

doi = {10.1097/txd.0000000000000938},

issn = {2373-8731},

year  = {2019},

date = {2019-00-00},

urldate = {2019-00-00},

volume = {5},

number = {11},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {Increasing organ donation rates in Australia have been exceeded by a rise in potential donor referrals not proceeding to donate. Referral evaluation is resource-intensive. We sought to characterize organ donor referrals in New South Wales, Australia, and identify predictors of referrals not proceeding to donation.

We performed a cohort study of NSW Organ and Tissue Donation Service logs 2010–2015, describing the prevalence and impact of comorbidities on referral outcome. Logistic regression was used to identify comorbidities influencing outcome and predict probability of donation.

Of 2977 referrals, 669 (22%) donated and 2308 (78%) did not. Despite increasing donation rates, the proportion proceeding to donate declined 2010–2015. Among referrals, the prevalence of all comorbidities except cerebrovascular disease increased and was higher among nondonors. History of cardiac disease, ≥65 years of age, chronic kidney or liver disease, malignancy, and absence of cerebrovascular disease were all significantly (P< 0.01) associated with non donation. Hypertension and diabetes did not significantly impact outcome. Predicted probability of donation varied from <1% to 54% depending on comorbidity burden of the referral.

Comorbidity burden among donor referrals is increasing. The presence of particular comorbidities may significantly impact referral outcome. A better understanding of referral characteristics associated with non donation may improve the efficiency of the referral process in the context of encouraging routine referrals.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}