Solid organ donation from the emergency department – missed donor opportunities

Abstract

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.

Preventable harm in the Canadian organ donation and transplantation system: a descriptive study of missed organ donor identification and referral

“… 16 Finally, an Ontario ED donor audit found ten postmortem referrals that potentially would have increased the hospital’s donation rate, had they been referred. 17 While the problem of IDR has been broadly described, our study is unique in quantifying its downstream preventable harm as a safety event.…”

Analysis of Factors Affecting Emergency Physicians’ Attitudes toward Deceased Organ & Tissue Donation

“…Overseas, the organ donation procedures are linked with the clinician’s awareness of the possibility of organ donation in the process of deferring end-of-life care or stopping LST. 21 22 23 The Australian College of Emergency Medicine publishes and revises the document stipulating the role of EPs in the donation process every 3 years. If a suspected brain death occurs in the ED, the patient is admitted to the intensive care unit, where the medical staff must contact the department or staff responsible for OTD before stopping the patient’s LST.…”

Just the facts: withdrawal of life-sustaining therapy in the ED

“…Along with the discussion around withdrawal of life-sustaining therapy, patients and their families should be offered a conversation about organ donation. The ED is a well-documented source of missed opportunities for organ donation, often because withdrawal of life-sustaining therapy occurs before referral to an organ donation organization is even considered [5]. The treating physician does not need to carry out this discussion themselves, but should offer the opportunity to speak in further detail with an organ donation organization prior to withdrawal of life-sustaining therapy.…”