Obtaining organ donation: Who should ask?

OBJECTIVE: To assess the impact of a decoupled presentation of the option of organ donation by an organ procurement organization representative on organ donation rates. DESIGN: Retrospective chart review. SETTING: A tertiary care university medical center. SUBJECTS: Patients declared dead by neurologic criteria during the 2-year period January 1, 1992, through December 31, 1993. INTERVENTION: The addition, for the calendar year 1993, of an institutionally dedicated organ procurement organization representative to present the option of organ donation with use of the technique of decoupling. RESULTS: The rate of donation increased from 38% to 59% with the addition of an institutionally dedicated organ procurement organization representative and the routine use of decoupling. CONCLUSIONS: When a dedicated representative from the local organ procurement organization, rather than the physician, presents the option of donation and decouples the discussion of death by neurologic criteria from the presentation of the option of donation, the rate of donation significantly increases.