Organ donation

Kidney transplantation has been and continues to be dependent on the apparently unscientific and decidedly personal act of organ donation. In the best-performing regions of the world, 75–95% of those who are medically suitable actually become donors upon their deaths, but because of increasing rates of organ failure, even in these high-performing areas, waiting lists continue to grow. Deceased organ donation performance is highly variable even among medically developed countries, and it is especially challenged in countries with cultural, legal, ethical or religious, economic, clinical, or organizational practices that limit donation. Recognizing these challenges, the transplantation community has collaborated to identify and promulgate international best practices and to foster innovation in the management of deceased donation. The goal of this effort is to clarify the organizational structures, social change interventions, and medical practices necessary to maximize both living and deceased donation. Although donation practice differs significantly across countries, successful organ donation programmes share certain traits and practices that can be modified to fit varied medical delivery reimbursement and social systems and structures. The world’s best-performing donation programmes have focused on increasing the public’s and healthcare professionals’ trust in the donation process, ensuring equitable access to transplantation, and they have built donation organizations that borrow from the theory and practice of business and healthcare management systems. The critical processes, essential functions, job roles, and foundational principles of successful donation programmes require the use of the tools that have been shown to improve donation and increase transplantation, thereby reducing (or, ideally, ending) deaths on the waiting lists. The wider adoption of these tools by countries with fledgling or struggling organ donation would increase organ availability and its exploitation of the poor who in many countries become organ ‘vendors’ rather than donors.