Regional and temporal variations in organ donation across the UK (secondary analyses of databases)

Objectives: To explore regional variations in donation of cadaveric solid organs and tissues across the four devolved health administrations of the UK (England, Scotland, Wales and Northern Ireland). Design: A secondary analysis of databases from NHS Blood & Transplant (1990-2009) and from the National Organ Procurement Service for the Republic of Ireland, Eurotransplant International Foundation and Scandiatransplant. Results: After adjusting for time, statistically significant differences were found among the four regions (p<0.001) for liver donations. The only exceptions were between England and Scotland and between Wales and Northern Ireland where the differences were not significant following a Bonferroni correction (p>0.008). England had significantly fewer heart donations than both Wales (p<0.001) and Northern Ireland (p=0.005). There were no significant differences among the four regions for lung donations. Regional variations in kidney and corneal donations were moderated by time. Northern Ireland, however, has had consistently lower corneal donation rates than the other three regions. Conclusion: Organ donation rates over the last two decades vary in the four UK regions, and this variation depends on the type of organ donated. Further exploration of underlying factors, organisational issues, practices and attitudes to organ donation in the four regions of the UK, taking into account findings from EU countries with varying approaches to presumed consent, needs to be undertaken before such legislation is introduced across the UK.