Solid organ donation from the emergency department – A systematic review

Abstract

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.

CAEP, CCCS, and CNSF Position Statement – Management of devastating brain injuries in the emergency department: Enhancing neuroprognostication and maintaining the opportunity for organ and tissue donation

“…In addition, it allows for a timely referral to the provincial organ donation organization, ensuring that patients and their families are given sufficient opportunity to consider organ and tissue donation. A recent systematic review 6 of ED deaths revealed that a substantial proportion (46.2-84%) of potential organ donors was missed due to a failure to refer for consideration of organ donation, in part, due to incorrect assumptions regarding eligibility criteria and failure of the healthcare team to refer for consideration of donation. In Ontario, over the 2017-2018 to 2018-2019 fiscal years, 33 (19%) of 178 patients who died in the ED and were not referred to the organ donation organization had organ donation potential (unpublished data, Trillium Gift of Life Network, 2019).…”

Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study

“…The diagnosis of BD may be delayed if routine neurological examination is delayed while patients are being treated for other systemic disorders, and by a lack of communication with transplant coordinators (15). A review of cases of BD that occurred in emergency departments found that up to 84% of cases were not diagnosed due to failure of the diagnostic process (16).…”

Organ donation – emergency medicine's call to action

“…Although the authors found that a variable percentage of potential donors are referred while in the ED (between 4%-50% of NDD and 3%-9% of DCD donors), the most striking finding is the number of missed opportunities within the department; some of their studies reported that as many as 84% of potential donors dying in the ED were missed. 2 This, in our view, is simply unacceptable, and represents a call to action. The authors highlight that nearly all opportunities are missed as a result of failure to refer to the ODO prior to the withdrawal of invasive physiologic support, after which the opportunity to donate is lost.…”

“…McCallum et al performed a systematic review to describe solid organ donation arising from identification and referral of patients while they were in the ED. 2 Ellis et al conducted a survey of waiting ED patients to determine the receptiveness to receive information about organ donation and even to register their consent during the ED visit. 3 Both studies shed light on the opportunities and challenges of organ donation arising in the ED, as well as provide insights into where professionals can focus efforts on improving performance and honor the wishes of our dying patients.…”

“…The work by McCallum et al highlights the scale of the donation work that we already do in the ED while providing some sobering data on where we could improve performance, prognostication, end-of-life care, and save the lives of those waiting for transplants. 2 Ellis et al provide us with some initial interesting insight into how we might provide information to a receptive audience in the ED, potentially increasing vital consent registration rates. 3 In Canada, because of the mismatch of supply of suitable organs for transplantation, it is estimated that every three days a patient dies while waiting for an organ transplant.…”