Maximizing the use of potential donors through increased rates of family approach for authorization

Macey L. Levan, Allan B. Massie, Chad Trahan, Jonathan Hewlett, Tyler Strout, Samantha B. Klitenic, Karen B. Vanterpool, Dorry L. Segev, Bradley L. Adams, Patricia Niles

Research output: Contribution to journalArticlepeer-review


In the United States, a small proportion of potential deceased organ donor referrals lead to donation and recovery. Understanding variation in the processes involved between organ procurement organizations (OPOs) may help increase deceased donation and reduce the organ shortage. We studied 103 923 referrals from 10 OPOs from 2018 to 2019, of which 14.4% led to approach for authorization, 8.2% led to authorization, 5.1% led to organ recovery, and 4.8% led to transplantation. First-person authorization (FPA) was associated with threefold higher odds of donation (OR = 2.83 3.02 3.22, p <.001). Female referrals had 11% lower odds of approach; when approached, Black and Hispanic referrals had 46% and 35% lower odds of authorization, respectively (all p <.001). There was substantial OPO-level variation in rates of approach, authorization, and organ recovery, which persisted after adjusting for age, sex, race, and FPA status. An OPO's relative rate of approach correlated strongly with its relative rate of donation among all referrals (ρ = 0.43). Correlation between an individual OPO's authorization rate among approached families, and overall rate of donation, was negative, suggesting that high authorization rates may be the result of selective approach practices. Therefore, approaching a higher proportion of families for authorization may lead to higher donation rates.

Original languageEnglish (US)
Pages (from-to)2834-2841
Number of pages8
JournalAmerican Journal of Transplantation
Issue number12
StatePublished - Dec 2022


  • donor family authorization
  • donor potential
  • health services and outcomes research
  • organ allocation
  • organ availability
  • organ procurement
  • organ procurement organization
  • solid organ transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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