Working Conditions for Donor Responsible Doctors in Norway

Introduction: The Spanish Model for organ donation highlights the appointment of an in-house donor responsible doctor (DRD) as one key factor for success. In 2002 The Norwegian Government instructed all donor hospitals to appoint a DRD, and provide sufficient funding to fulfill the task. In a circular issued by The Ministry of Health and Care 2003, the hospitals were obliged to develop a system for follow up of all possible organ donors with the intention to achieve an organ donation. Five years later, through the National Activity Based Funding System, a cost reimbursement for each realized donation was set into action. The donation rate has increased from 13,6 pmp in 2002 to 25,6 pmp in 2011. DRDs are one of several possible factors contributing to this. Methods: Since 2003, The Norwegian Resource Group for Organ Donation (NOROD) has performed a annually survey by questionnaire to reveal the working conditions for all DRDs, the majority being ICU doctors. Data were analyzed by frequencies. Results: The overall response rate was 70%. In 2004 15% had a job description, increasing to 60 % in 2010. Only 11 % had time appointed to perform their task in 2004. In 2010 65% reported that they could: a) use a predefined percentage of their total working hour for donation purposes or b) use the time necessary, as defined by themselves. The rest had to perform this duty in addition to their ordinary tasks. Fifteen percent of DRDs had in 2004 other resources at their disposal (economic or manpower), increasing to 36% in 2010. On the question: “Is it possible to increase the donation rate in your hospital?”, 24% answered “yes” in 2005, 55% in 2010. In 2010 45% reported that hospital administration had not implemented an effective follow up system for possible organ donors. Conclusion: Eight years after introduction of in-house DRDs their working conditions are still unsatisfactory, but an improvement is registered in the period. National health authorities should develop methods to supervise and ensure that donor hospitals fulfill the governmental directives on this issue.