Organ donation in the Basque country: 18 years experience.

Purpose: We reviewed of the trends in organ donation within a coordinated transplant program over the last 18 years.

Methods: Two thousand three hundred and fifty five potential donors (PD) were evaluated in 18 years including 1282 who were effective donors (EDs) and the 4081 harvested organs. A retrospective analysis of various parameters was performed comparing four different periods: 1981 to 1986 (P0); 1987 to 1992 (P1); 1993 to 1998 (P2); and 1999 to 2004 (P3).

Results: The potential donor detection rate (PD/PMP) increased from 18 in P0 to 47 in P3. The ED rate (ED/PMP) was 10 in P0 and 47 in P3. Organs donated ED evolved from 2.8 in P1 to 3.3 in P3. Mean donor age increased: 32 years in P1 and 53 in P3. ED/PD rate did not vary significantly in the three periods: P1, 54%; P2, 53%; and P3, 55%. There was a change in the main causes of death among our EDs: 54% head trauma, 36% stroke, and 16% other causes in P1 versus 30% head trauma and 64% stroke in P3. Failed donations due to medical contraindications were in P1 17% and in P3; whereas failed donation due to donor management problems and family denials to donation, both dropped: P1 16%; P3 10% and P1 13%; P3 7%, respectively.

Conclusions: The ED rate increased almost fivefold since 1981 to 1986. We think that this was the result of a better detection since the beginning of our program. Failed donation due to medical exclusion criteria along with the mean donor age of our donors increased, but we noticed a significant drop in family denials and exclusions secondary to donor management problems. Our donor profile has changed considerably during 18 years: an increase of more than 20 years in the mean donor age along with an increase of more than 28% among strokes as the cause of death, leading to more failed donations secondary to medical exclusion criteria.