Review of organ donation in Hong Kong: 1996-2009.

Background A retrospective review of the data entries from the Organ Procurement System of the Hong Kong Hospital Authority from January 1996 to December 2009, a 14-year period, was done. The characteristics of donors and organ utilization patterns among deceased donors in Hong Kong were analyzed. Methods A total of 1,183 organs were recovered during the study period, including 749 kidneys (63.3%), 308 livers (26.0%), 94 hearts (7.9%) and 32 lungs (2.7%) from 438 deceased organ donors; 59.4% of the donors were male. The median age of the donors increased from 38.8 years in 1996 to 50.2 in 2009. The two major causes of death amongst these donors were cerebrovascular accidents ( n = 300, 68.5%) and head trauma ( n = 93, 21.2%). There was a fourfold increase in expanded-criteria donors from 10% in 1996 to 40.5% of the total donor pool in 2008. Results Four factors—family decision, donor characteristics, donor medical background and donor management—were identified as contributory factors to the success of organ recovery. Outcome of donation is referred to as organs recovered per donor (ORPD). The yearly trend of ORPD ranged from 2.41 to 3.00, and the mean ORPD was 2.70 over the past 14 years. At least three organs were utilized from 263 (60%) donors. Organ yield was found to depend significantly on cause of death (cerebrovascular accident yield, 2.59 organs/donor; head trauma yield, 3.18 organs/donor) and donor age. The younger donors tended to be multiple organ donors. Donors at the extreme ages of below 5 and above 70 tended to be single-organ donors. Conclusion We found that 608 (51.4%) organs came from 220 (50.2%) donors cared for in intensive care units, and 309 (26.1%) organs came from 109 (24.9%) donors cared for in neurosurgical units. The work of critical care personnel in caring for potential donors before confirmation of brain death and the subsequent maintenance of the donors is therefore essential. In the majority of donors ( n = 281, 64.2%), the time period from intubation to confirmation of brain death was within 48 hours. The number of donors decreased markedly when time between intubation and brain death was longer than 72 hours. Timely and accurate declaration of brain death can promote smoother transition from patient care to donor management and a better outcome. Therefore, collaborative and effective donor management is vital to optimize organ utilization from every consensual donor.