Deceased solid organ donors Recent trends from ANZOD Stephen McDonald

Aims Review recent changes in deceased donor numbers & rates by different metrics Highlight trends in donor characteristics Consider how these will affect potential future recipients

Donor numbers

Population

Donor rates

Brain vs circulatory death

Donor ages

Age-specific donor rates

Deaths as denominator

Population death rates Age-standardised death rate, Australia, ABS 33020

Age-specific donor rates by death rate

Cause of death

Age and cause of death

Proportion who are kidney donors

Donor age and organs utilised

Donor comorbidities

Donor comorbidities

Donor comorbidities

Kidney function at donation

Kidney biopsy Kidney(s) not utilised Kidney(s) transplanted Total Retrieval biopsy 47 (67%) 464 (14%) 511 No retrieval biopsy 23 (33%) 2800 (86%) 2823 70 3264 3334 All utilised donors, Australia and New Zealand.

Kidney function

Outcome predictors

Outcome predictors Explanatory power of multivariate Cox model for graft failure for recipients 2001-11, Australia and New Zealand

Summary Profound changes in donor rates 50-59 and 60-69 rate per 10000 deaths have doubled over past 6-7 years Steady increase in rate among younger donors Predominantly “medical” rather than traumatic causes of death Metric is important Population is rising faster than number of deaths=falling death rate

Summary DCD a major component of increase Increase seen across all age groups In absolute terms, increase greatest in 50-69 year age groups Older donors, more “medical” donors Almost 10% of donors have diabetes, and 20% hypertension Age of donor (rather than cause of death) is the key factor in outcomes Use of biopsies is uncommon, but associated with a much higher chance of non-utilisation.

Time to donation Median number of days from admission to donation =2

Age by organs retrieved

Age/gender over time