The study says that general hospitals which don't have transplant programs are the places where most people die, yet fewer organs are collected in them.
In fact, the study showed that large general hospitals have a donor rate of 1.4 per 100 deaths, compared to five per 100 deaths in hospitals with transplant programs.
In Ontario, where the study was done, that's the equivalent of about 121 missed donors a year.
Dr. Donald Redelmeier, lead author of the study, says this suggests education efforts aimed at large general hospitals could increase the number of donor organs available for transplant.
The study is published in this week's issue of The Canadian Medical Association Journal.
"The findings suggest that optimizing organ donation needs to focus attention on large general hospitals that account for most of the potential donors and most of the missed opportunities," said Redelmeier, the director of clinical epidemiologist at Toronto's Sunnybrook Health Sciences Centre.
"And the corollary to that is that the shortfall also means that actual organ donation may not always follow what the individual patient had wished. And the failure there isn't that they procure organs that they had no consent to, it's that by far and away the more common mistake is the failure to procure organs that the patient had wished to donate."
The study found that people who died in large general hospitals tended to be older than those who died in hospitals with transplant programs. But that doesn't mean their organs couldn't be valuable, Redelmeier says.
"A 65-year-old liver is about the same as a 35-year-old liver and could end up doing a lot of good if transplanted appropriately."
The study suggests some of the differential may be about age discrimination — assumptions that older organs aren't wanted.
Another part of the problem may be the work entailed in preserving a would-be donor until a transplant team can collect the organs. Redelmeier admits it can be hard on hospitals to maintain potential donors because of the resources that eats up.
"It's never going to be totally easy. Because when you've got a brain dead patient, it is quite a struggle to maintain donor viability on artificial respiration . . . and very, very complicated medications that almost invariably will require some quite intensive work by the nurses and the doctors in the critical care unit," he says.
Redelmeier says most of the transplant education and awareness work currently focuses on the few major centres that perform transplant procedures. Broadening the scope to help general hospitals think about themselves as part of the transplant team could help, he suggests.