Effective—providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and avoiding overuse, respectively)
Patient centered—providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions
Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care
Efficient—avoiding waste, including waste of equipment, supplies, ideas, and energy
Equitable—providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
These goals are highly relevant to the challenges facing the organ donation and transplantation system. These challenges include ensuring a patient- and family-centered system, providing equitable access to transplantation through the elimination of economic and ethnic or cultural barriers, increasing trust and confidence in the system, and providing the care needed to optimize the value of the transplant to the recipient.
As previous IOM studies on improving the quality and safety of U.S. health care have concluded, improving care requires a focus on systems, not on the individuals within those systems (IOM, 2000a). “[E]very system is perfectly designed to achieve the results it achieves” (Berwick, 1996, p. 619). Hence, if the results are unacceptable, the system’s design must be changed.
This chapter focuses on the clinical systems issues that are specific to the organ donation process. It is important to note, however, that an equitable allocation system and ongoing attention to the recipient are vital to maintaining the value of the donated organ and sustaining the integrity of the entire organ transplantation system (Box 4-1). Although these allocation issues are beyond the scope of this report, addressing them is indispensable to achieving a trustworthy organ donation system and thereby increasing the rates of donation. Additionally, several aspects of tissue donation and the market for tissue-related products need attention in order to ensure the credibility of the entire donation system.
The chapter begins with a brief overview of the issues facing the U.S. organ donation system, provides a snapshot of ongoing efforts, and concludes with recommendations for next steps to improve the system. As discussed throughout this chapter, there are many opportunities to build on existing practices and to leverage ongoing quality improvement efforts to expand knowledge and implement best practices. Clinical care at the end of life receives the main attention in this chapter, while emergency care and resuscitative care are examined in Chapter 5.