Introduction: National regulatory organizations including CMS require that hospitals refer all potential organ and tissue donors to an Organ Procurement Organization (OPO). To replace the current time-consuming and error-prone telephonic referral process, secure, direct, electronic donor referral interfaces are pursued and launched across the country, including automated donor referral triggers to ensure referrals not be missed and be made in a time-sensitive fashion. The goals of implementation are to 1) increase the number and timeliness of referrals (and thus transplantable organs); and 2) reduce Hospital and OPO resource costs.

Method: The secure technical interface (“iReferral”) directly connects the OPO and Hospital systems and is accompanied by seamless donor referral triggers within the Hospital EMR. These triggers automatically prompt delivery of electronic donor referrals from the Hospital to the OPO upon pre-determined clinical triggers in the EMR, greatly reducing the need for decision-making and donation knowledge by the hospital staff. An additional trigger option allows staff to “one click” electronically refer for cases such as end-of-life discussions. Immediately the OPO receives a new referral auto populated with actionable patient information and real-time notifications alert OPO staff. The interface automatically returns the associated OPO referral ID number to the patient’s EMR to provide confirmation to the referring clinician. This interface is currently implemented at 50 hospitals across the country, with hundreds more forthcoming.

Results: At a pilot hospital, annualized data after the first year of implementation demonstrated 49% increase in vented referrals and 78% increase in organs transplanted. At another hospital network including 18 facilities, within the first four months of launch there was a 38% increase in vented referrals and an estimated 333 hours of nursing time saved. This same hospital network a year later is sending 95% of referrals (over 1,000) electronically. There are also several case studies of the OPO receiving an automatically triggered donor referral when the nurse was unable to connect on a phone call due to duties in a busy ICU. OPO staff were then able to retrieve the appropriate data directly from the EMR, allowing them to mobilize and ultimately recover organs and tissue which likely would have otherwise timed out.

Conclusion: This interface has met the goals of the project to 1) increase the number and timeliness of referrals (and thus transplantable organs); and 2) reduce Hospital and OPO resource costs. Carefully tuned automatic donor referral triggers directly address known challenges with busy and/or new hospital staff correctly and reliably identifying patients meeting criteria for OPO referral. There is unlimited potential for streamlining the referral process through donor referral interoperability solutions, ultimately leading to more donors and transplantations.