End-of-Life Conversations With Families of Potential Donors

Shemie, Sam D.; Robertson, A.; Beitel, Janice; Chandler, Jennifer A.; Ferre, Ed; Evans, Janet; Haun, Mathias; Torrance, Sylvia

doi:10.1097/tp.0000000000001696

Cited by 49 publications

(21 citation statements)

References 1 publication

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“…Canadian donation guidelines recommend that it should be an organ donation organization that approaches families to discuss the opportunity to donate, which would decrease the burden on ED healthcare providers. 8 The cases where a notification was never made to the Trillium Gift of Life Network are significant, as provincial law in Ontario mandates that the Trillium Gift of Life Network be notified as soon as possible after death, or if a physician believes that the death of a patient is imminent (Trillium Gift of Life Network Act, R.S.O 1990, c. H.20 Part II.1 8.1). No notification of the organ donation organization prevents the opportunity for donation for families and may be contrary to the wishes of the dying patient if they wished to be an organ donor.…”

Section: Discussionmentioning

confidence: 99%

Solid organ donation from the emergency department – missed donor opportunities

McCallum¹,

Yip²,

Dhanani

et al. 2020

CJEM

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Objective A significant gap exists between people awaiting solid organ transplantation and solid organ donors. The purpose of this study was to determine whether there were missed donors in the emergency department (ED). Methods We performed a health records and organ donation database review of all patients dying in a large tertiary ED from November 1, 2014 to October 31, 2017 at two campuses with 160,000 visits per year. Demographic and donor suitability data were collected. The primary outcome was missed potential solid organ donors. Missed potential donors were intubated, had a pulse, and had no donation contraindications. The secondary outcome was cases where no notification was made to the organ donation organization at all. Results There were 605 deaths in the ED. Patients had a mean age of 71.1 years, 58.3% were male, and 12.4% died of a traumatic cause. There were 10 missed potential donors. Missed potential donors had a mean age of 67.4 years, 70.0% were male, and 20.0% died from trauma. In all 10 cases, patients had withdrawal of life-sustaining therapy for medical futility, and referral for donation occurred after death. Missed ED donors could have increased hospital-wide donation up to 10.6%. No notification was made in 12 (2.0%) cases; however, none of these would have been successful solid organ donors. Conclusion The ED is a source of missed organ donors. All potential donors were missed due to referral after withdrawal of life-sustaining therapy. ED physicians should consider the possibility of solid organ donation prior to the withdrawal of life-sustaining therapy.

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Section: Discussionmentioning

confidence: 99%

Solid organ donation from the emergency department – missed donor opportunities

McCallum¹,

Yip²,

Dhanani

et al. 2020

CJEM

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“…6 Recent Canadian guidelines have been developed regarding the process of consent and approaching families. 36 The role of the physician is to ensure that the organ procurement organization has been contacted. These guidelines also recommend the healthcare team involved in patient care not approach the family regarding organ donation until an organ donation organization has been contacted.…”

Section: Discussionmentioning

confidence: 99%

Solid organ donation from the emergency department – A systematic review

McCallum

Ellis

Dhanani

et al. 2019

CJEM

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ObjectivesA significant gap exists between people awaiting an organ transplant and organ donors. The purpose of this study was to determine what percent of successful donors come from the emergency department (ED), whether there are any missed donors, and to identify factors associated with successful and missed donation.MethodsThis systematic review used electronic searches of EMBASE, MEDLINE, and CINAHL according to PRISMA guidelines on July 7, 2017. We included primary literature in adults describing successful and missed organ donation. Two authors independently screened articles, and discrepancies were resolved through consensus. Quality was assessed using the STROBE checklist.ResultsThis systematic review identified 1,058 articles, and 25 articles were included. For neurologic determination of death, ED patients comprised 4%–50% of successful donors and 3.6%–8.9% of successful donors for donation after circulatory determination of death. ED death reviews revealed up to 84% of missed neurologic determination of death, and 46.2% of missed circulatory determination of death donors who died in the ED are missed due to a failure to refer for consideration of organ donation. Clinical heterogeneity precluded pooling of the data to conduct a meta-analysis.ConclusionsThe ED is a source of actual and missed donors. Potential donors are often missed due to incorrect assumptions regarding eligibility criteria and failure of the healthcare team to refer for consideration of donation. ED healthcare professionals should be aware of organ donation referral protocols at their institution to ensure that no organ donors are missed.

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“…15 In addition, participants emphasized the importance of having family discussion in private settings; hence, holding family meetings in a private setting is modifiable and improves family experience. 16,[21][22][23]…”

Section: Discussionmentioning

confidence: 99%