Background: The number of deceased donors in the UK has increased from 809 in 2007-8 to 1088 in 2011-2. This increase can be ascribed, predominantly, to the increased use of donation after circulatory death donors (DCD). We aimed to describe the regional variation in donation rates in UK to evaluate the potential for further increases in donor numbers. We also aimed to describe the views of donation clinicians from each of the transplant zones involved in organ donation.

Methods: The study was in two parts: firstly, a cohort of deaths in UK critical care units that occurred between April 2010 and December 2011 were selected from the UK transplant potential donor audit. Logistic regression analysis was used to identify the factors associated with kidney donation. The logistic regression model was used to produce risk-adjusted funnel plots describing the regional variation in donation rates. The second part of the study is a report on the views of key donation clinicians based on 54 semi-structured interviews from 27 donation and transplant centres in the UK.

Findings: 1528 kidney donors were identified from 27,482 patients who died in critical-care. Death in a neurosurgical ICU (compared to a general ICU) was more likely to result in donation (OR 1.55, 95% CI 1.36-1.78, p < 0.0001), as was death from trauma or stroke (compared to other causes), white ethnicity (compared to other ethnic groups) and being aged between 18 and 40 (compared to other ages) (p < 0.0001 for all). There is significant regional variation in risk-adjusted donation-rates, particularly for DCD donation. Clinicians involved in donation supported DCD donation in general, and believed it was likely to play an increasingly important role in organ donation in the UK.

Conclusion: There is marked regional variation in DCD kidney donation rates, even after adjustment for differences in regional demographics and infrastructure. This suggests that, despite the increase in donor numbers, there is significant untapped donation potential in the UK.

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