Introduction: Worldwide, organ donation and transplantation has become a practice that can prolong and improve quality of life. While organ donation from deceased donors has increased exponentially over the years, the supply and availability of donors remain insufficient. (1) Implementation of safety and quality protocols within the health care organization is required to maintain public trust and effectiveness of organ donation and transplantation programs. (2) These guidelines aim to guarantee complete documentation and transparency throughout the process, from donation to transplant, enabling traceability and further assessment for continuous improvement of the system. (2) Moreover, to provide local, national, and regional data that allows to compare outcomes of the implementation of specific quality indicators, such as sociodemographic characteristics, health care structure, and economy.

Method: The study is multicenter, retrospective analysis of all deaths reported between January 2015 and December 2019 in the intensive care unit (ICU) of two trauma centers in Dominican Republic with Brain Death Donors (DBD) programs within their neurosurgery units and a transplant coordinator on-site. Indicators of the DOPKI study (3) were used to measure the donation potential, the effectiveness of the donation process, and the points to improve in the organ donation process for public policies be instated.

Results: From all deaths reported in ICU between 2016-2019, the median potentiality for DBD was 27.5% and 6.2% in hospital A and B, respectively. Conversion rate of all the brain deaths to real donors was 6.2% and 5.9%, being 2019 the year with the highest conversion rate. Major causes of donor loss were family refusal (26.3% and 14.8%) and donor maintenance failure with (21.2% and 23.5%).

Conclusion: While both hospitals shared the highest rate of devasting cerebral lesions cases in the country and manage similar number of neurotrauma in their ICUs, hospital A showed better indicators for donor potentiality when compared to hospital B. These findings might be attributed to the lack of a 24/7 donation team to help detect in time potential organ donors and the need to implement an alert system to notify the donation team when these cases occur. The low conversion rates on both hospitals are due importantly to high rates of family refusals and donor maintenance failure and should be areas of improvement. National media campaigns raising awareness and emphasizing values ​​of altruism and solidarity improve the perception of families and society about organ donation and decrease the family refusals. The development of a Donor Management Protocol must be carried out and established, to be implemented in hospitals with donor-generating capacity created by a multidisciplinary team lead by of the National Government Transplant Office and socialized with all the key professionals involved in organ donation and transplantation to minimize the maintenance failure.