Missed opportunities for organ donation in patients with intracranial haemorrhage at the emergency department: A single-centre study

Abstract

Background: The demand for transplantable organs has increased in Singapore. However, organ donation has been consistently lower than international standards. Donation after brain death (DBD) most commonly follows intracranial haemorrhage (ICH). Objective: Our aim was to identify missed opportunities for organ donation among those who presented to the Emergency Department (ED) and died following ICH. Methods: A retrospective study was carried out for all cases of ICH presenting to the ED from 1 January 2013 to 31 December 2017. The patients' medical records were reviewed for identification of potential donors and actualisation of organ donation. Results: There were 615 cases of ICH, with a mortality rate of 6.0%. Among those who died, 28 (75.7%) died in the Intensive Care Unit (ICU) and nine (24.3%) patients had withdrawal of care in the ED. Thirty patients (81.1%) were potential donors but organ donation was actualised in only three (8.1%) patients. Thirteen organs, as well as heart valves and iliac vessels were retrieved from the organ donors for transplantation. Conclusion: There were missed opportunities for organ donation. EDs have an important role to play in the national organ donation programme by identifying potential donors for organ donation and considering admitting these patients to ICU to facilitate organ donation.