Perceived Versus Verified Cancer History and Missed Opportunities for Donation in an Australian Cohort of Potential Deceased Solid Organ Donors

James A Hedley; Patrick J Kelly; Karen M J Waller; Imogen K Thomson; Nicole L De La Mata; Brenda M Rosales; Kate Wyburn; Angela C Webster

doi:10.1097/TXD.0000000000001252

Perceived Versus Verified Cancer History and Missed Opportunities for Donation in an Australian Cohort of Potential Deceased Solid Organ Donors

Transplant Direct. 2022 Jan 13;8(2):e1252. doi: 10.1097/TXD.0000000000001252. eCollection 2022 Feb.

Authors

James A Hedley¹, Patrick J Kelly¹, Karen M J Waller¹, Imogen K Thomson¹, Nicole L De La Mata¹, Brenda M Rosales¹, Kate Wyburn^{1

2}, Angela C Webster^{1

3

4}

Affiliations

¹ Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
² Renal Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
³ Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.
⁴ National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, NSW, Australia.

Abstract

Background: There is an imperative to maximize donation opportunities given ongoing organ shortages, but donor suitability assessments can be challenging.

Methods: We analyzed an Australian cohort of potential deceased donors 2010 to 2013 to explore misclassification of cancer risk and potential strategies for improvement (decision support, real-time data linkage to existing data sets, and increasing risk tolerance). Cancer history perceived at referral was compared with verified cancer history in linked health records. Transmission risks were based on clinical guidelines. Potential donors declined due to cancer but verified low risk were missed opportunities; those accepted but verified high risk were excess-risk donors.

Results: Among 472 potentially suitable donor referrals, 132 (28%) were declined because of perceived transmission risk and 340 (72%) donated. Assuming a low-risk threshold, there were 38/132 (29%) missed opportunities and 5/340 (1%) excess-risk donors. With decision support, there would have been 5 (13%) fewer missed opportunities and 2 (40%) more excess-risk donors; with real-time data linkage, 6 (16%) fewer missed opportunities and 2 (40%) fewer excess-risk donors; and with increased risk tolerance, 6 (16%) fewer missed opportunities and 11 (220%) more excess-risk donors.

Conclusions: Potential donors' cancer history is typically incomplete at referral. There are missed opportunities where decision support or more accurate cancer history could safely increase organ donors.