J. W. Harris1, J. C. Berger1, R. Gedaly1, M. B. Shah1 1University Of Kentucky,Surgery,Lexington, KY, USA
Introduction: Appalachia is a distinct region characterized by high levels of poverty, poor access to healthcare and a high incidence of end stage organ disease. However, there is little reported regarding the availability and characteristics of potential organ donors. There is a need to understand factors that may impact consent for donation in potential donors residing in Appalachia.
Methods: All Appalachian potential donor (APD) referrals to our OPO from 2007-12 were analyzed. Death certificates for each APD were obtained. Demographics, marital status, education, registry status, cause and manner of death, decoupling, family member approached, understanding of hopelessness by family, and hospital region were collected. The US Census Report was used to obtain median county income and poverty rates. An analysis for donation consent was performed.
Results: 493 APD referrals were included. 207 consented for donation (CD) and 286 did not consent for donation (DNC). Those who CD were significantly younger (38 vs. 49 years, p<0.001). There were no differences in income. On univariate analysis, APD has lower CD if: age >40 vs <40 (32 vs 60%, p<0.001), high school or less education vs college (41 vs 58%, p<0.05), not registered vs on registry (38 vs 82%, p<0.001), OPO vs local provider vs family mentioned donation (37 vs 41 vs 73%, p<0.001), spouse/siblings/children vs parents approached for donation (35 vs 63%, p<0.001), if family did not understand hopelessness (20 vs 45%, p=0.009), declaration of death and approach for consent not decoupled (22 vs 47%, p<0.001), other cause of death vs trauma (36 vs 57%, p<0.001), medical vs non-medical mechanism of death (34 vs 54, p<0.001). There were no significant differences between race, APD gender and marital status, hospital region, miles from home, gender of family member approached, and poverty levels of APD compared to US and state poverty rates.
On multivariate analysis, predictors of CD were: age <18 years (OR 5.6 p<0.001), age 18-39 years (OR 6.5, p<0.001), college education (OR 3.3, p=0.008), graduate school (OR 4.3, p<0.001), on donor registry (OR 8.3, p<0.001), family mentioned donation (OR 5.6, p<0.001) and decoupling declaration of death from approach for donation (OR 5.8, p<0.001).
Conclusion: It is not surprising that poverty rates do not correlate with donation since Appalachia is generally poorer than numerous other areas. However, several observed factors can help target at-risk groups for poor consent in APD. Higher levels of education, younger age and family awareness of organ donation are independently associated with higher rates of consent. While DMV collaborations are paramount, targeting groups with poor consent rates more directly in their local communities may help increase awareness and donor registration. Additionally, OPO and local provider collaborations may maximize donation during the hospital phase of donation in non-registered APD.