Development of the Nova Scotia Potential Donor Audit (PDA) Tool and 2020 Historic Performance Database: Lessons Learned From the First 1000 Medical Record Reviews

Kristina Krmpotic; Jade Dirk; Julien Gallant; Jennifer Hancock; Cynthia Isenor; Lee James; Alain Landry; Amy Laybolt; Karthik Tennankore; Matthew-John Weiss; Stephen Beed

doi:10.1097/TXD.0000000000001545

Development of the Nova Scotia Potential Donor Audit (PDA) Tool and 2020 Historic Performance Database: Lessons Learned From the First 1000 Medical Record Reviews

Transplant Direct. 2023 Oct 20;9(11):e1545. doi: 10.1097/TXD.0000000000001545. eCollection 2023 Nov.

Authors

Kristina Krmpotic^{1

2}, Jade Dirk^{2

3}, Julien Gallant⁴, Jennifer Hancock^{1

2}, Cynthia Isenor⁵, Lee James⁶, Alain Landry², Amy Laybolt⁵, Karthik Tennankore⁷, Matthew-John Weiss^{8

9}, Stephen Beed^{1

2}

Affiliations

¹ Department of Critical Care, Dalhousie University, Halifax, NS, Canada.
² Legacy of Life Provincial Organ Donation, Nova Scotia Health, Halifax, NS, Canada.
³ Department of Research and Innovation, Nova Scotia Health, Halifax, NS, Canada.
⁴ Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada.
⁵ Nova Scotia Health, Halifax, NS, Canada.
⁶ Canadian Blood Services, Vancouver, BC, Canada.
⁷ Department of Medicine, Dalhousie University, Halifax, NS, Canada.
⁸ Transplant Québec, Montreal, QC, Canada.
⁹ Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Trauma-Emergency-Critical Care Medicine, Université Laval, QC, Canada.

Abstract

Background: Legislation and accountability frameworks are key components of high-performing deceased-donation systems. In 2021, Nova Scotia (NS), Canada, became the first jurisdiction in North America to enact deemed consent legislation and concurrently implemented mandatory referral legislation similar to that found in other Canadian provinces. Frontline financial resources were provided by the government to support the development of program infrastructure, including implementation of means to evaluate system performance.

Methods: The Organ Donation Program (ODP), in collaboration with other stakeholders, developed a Potential Donor Audit (PDA) tool and database for referral intake and manual performance audits. Medical record reviews of deaths in the year before legislative change were conducted to pilot and revise the PDA and evaluate missed donation opportunities.

Results: The NS PDA was piloted on 1028 patient deaths. Of 518 patients (50.4%) who met clinical triggers for referral to the ODP, 72 (13.9%) were referred (86.1% missed referral rate). One hundred sixty-three patients met the NS definition of a potential donor; 53 (32.5%) were referred (110 missed potential donors). Referral consent rates reached 71.7% (n = 38 of 53 approaches). The actualized donation rate reported by Canadian Blood Services was 29.9 donors per million population (n = 34 donors).

Discussion: We documented high rates of missed referrals and missed potential donors before the enactment of mandatory referral and deemed consent legislation.

Conclusions: The ODP has intentionally broadened clinical criteria for referral to shift the responsibility of identifying medically suitable potential donors from bedside clinicians to organ donation specialists. Lessons learned from our experience developing a PDA include the importance of early involvement of multiple stakeholders and ongoing modification of fields and workflow based on data availability and utility for clinical, educational, research, and reporting purposes.