Introduction: It is common to read in the local press news like “Chile increases its organ donation rate by 20% in the last month”.  Despite the intention to highlight the positive things of the Chilean system, this is a simplistic analysis of a short period of time. You don't need to be a math expert to wonder at the end of the year why Chile still has a low donation rate, when all the headlines reported increases. If we study the medium- and long-term tendencies, we would observe that these headlines report local maximums of a time-series, and not of a tendency. But, what’s the tendency then?
Methods: With the objective of studying the evolution of the organ donation indicators, we fit linear regressions over time for effective donors (ED), familial refusal (FR), contraindications (C), and discards (D) of possible donors (PD). We used the database of the National Coordination of Organ Procurement and Transplantation of Chile between 2013 and 2022.
Results: The database had 21,658 observations. 24 were duplicates, and 466 were registered without being referred nor detected by the Local Procurement Coordination, thus were not considered. Amongst the 21,191 that entered procurement follow-up, 85.5% were D as PD, 1.4% were C, 6.6% were FR, and 6.7% were ED. The slopes of the linear regressions for each indicator were 0.01 (p=0.0146) for C, 1.71 (p< 0.0002) for D, 0.01 (p=0.243) for FR, and 0.05 (p=0.0003) for ED. We also observed a turning point between 2017 and 2018, which forced a separate analysis for both periods. For 2013-2017, the slopes were 0.002 (p=0.99), 0.02 (p=0.05), -0.18 (p=0.168), 0.06 (p=0.027), 0.10 (p=0.00015), respectively for PD in total, and for each indicator in the previous order. Whilst for 2018-2022, the slopes were 3.51 (p<0.0002), 0.0006 (p=0.955), 3.49 (p< 0.0002), -0.04 (p=0.289), 0.07 (p=0.105), respectively.
Conclusion: Conversely to what news suggest, Chile has not shown any increase in ED in the last 10 years. Although ED showed a subtle increase between 2013-2017, it was not statistically different from zero between 2018-2022. Both C and FR have had an “increase” of slope zero. D, on the other hand, are the ones that explain the significant difference between both periods. Increasing from slope 0.002 to 3.51 in PD entering procurement follow-up is solely explained by the increase in discarded patients, from -0.18 to 3.49. Even though there are plenty of factors that contribute to the increase of patients entering procurement follow-up and later discarded, there is only one quantifiable explanation. The high correlation of 0.95 between discarded patients and the number of hospitals contributing PD to the system, which has greatly increased over time (from ~20 to ~60). It is fundamental to include new hospitals to the procurement activity, but it is even more important to understand why patients are discarded, and to standardize the procurement process. Only with that we will be able to transform those D patients into ED.