P146: Organ and tissue donation from poisoned patients in the emergency department: a Canadian perspective

Introduction: Screening for organ and tissue donation is an essential skill for emergency physicians. In 2015, 4564 individuals were on a waiting list for organ transplant and 242 died while waiting. As Canadas donation rates are less than half that of other comparable countries, it is crucial to ensure we are identifying all potential donors. Patients deceased from poisoning are a source that may not be considered for referral as often as those who die from other causes. This study aims to identify if patients dying from poisoning represent an under-referred group and determine what physician characteristics influence referral decisions. Methods: In this cross-sectional unidirectional survey study, physician members of the Canadian Association of Emergency Physicians were invited to participate. Participants were presented with 20 organ donation scenarios that included poisoned and non-poisoned deaths, as well as one ideal scenario for organ or tissue donation used for comparison. Participants were unaware of the objective to explore donation in the context of poisoning deaths. Following the organ donation scenarios, a range of follow-up questions and demographics were included to explore factors influencing the decision to refer or not refer for organ or tissue donation. Results were reported descriptively and associations between physician characteristics and decisions to refer were assessed using odds ratios and 95% confidence intervals. Results: 208/2058 (10.1%) physicians participated. 25% did not refer in scenarios involving a drug overdose (n=71). Specific poisonings commonly triggering the decision to not refer included palliative care medications (n=34, 18%), acetaminophen (n=42, 22%), chemical exposure (n=48, 27%) and organophosphates (n=87, 48%). Factors associated with an increased likelihood to refer potential donors following overdose included previous organ and tissue donation training (OR=2.6), having referred in the past (OR=4.3), available donation support (OR=3.9), greater than 10 years of service (OR=2.1), large urban center (OR=3.8), holding emergency medicine certification (OR=3.6), male gender (OR=2.2, CI), and having indicated a desire to be a donor on government identification (OR=5.8). Conclusion: Scenarios involving drug overdoses were associated with under-referral for organ and tissue donation. As poisoning is not a contraindication for referral, this represents a potential source of donors. By examining characteristics that put clinicians at risk for under-referral of organ or tissue donors, becoming aware of potential biases, improving transplant knowledge bases, and implementing support and training programs for the organ and tissue donation processes, we have the opportunity to improve these rates and reduce morbidity and mortality for Canadians requiring organ or tissue donation.

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Organ and tissue donation from poisoned patients in the emergency department: A Canadian emergency physician survey

CJEM ◽

10.1017/cem.2018.43 ◽

2018 ◽

Vol 21 (1) ◽

pp. 47-54 ◽

Cited By ~ 2

Author(s):

Louis Staple ◽

Janet MacIntyre ◽

Nancy G. Murphy ◽

Stephen Beed ◽

Constance LeBlanc

Keyword(s):

Chemical Exposure ◽

Male Gender ◽

Tissue Donation ◽

Physician Survey ◽

Emergency Physicians ◽

Cross Sectional ◽

Physician Practices ◽

Organ And Tissue Donation ◽

Potential Source ◽

Canadian Association

AbstractObjectivesScreening for organ and tissue donation is an essential skill for emergency physicians. In 2015, 4,631 Canadians were on a waiting list for a transplant, and 262 died while waiting. Canada’s donation rates are less than half of comparable countries, so it is essential to explore strategies to improve the referral of donors. Poisoned patients may be one such underutilized source for donation. This study explores physician practices and perceptions regarding the referral of poisoned patients as donors.MethodsIn this cross-sectional unidirectional survey, 1,471 physician members of the Canadian Association of Emergency Physicians were invited to participate. Physicians were presented with 20 scenarios and asked whether they would refer the patient as a potential organ or tissue donor. Results were reported descriptively, and associations between demographics and referral patterns were assessed.ResultsPhysicians totalling 208 participated in the organ or tissue donation scenarios (14.1%); 75% of scenarios involving poisoning were referred for organ or tissue donation, compared with 92% in a non-poisoning scenario. Poisons associated with lower referrals included sedatives, acetaminophen, chemical exposure, and organophosphates. A total of 175 physicians completed the demographic survey (11.9%). Characteristics associated with increased referrals included previous referral experience, donation training, donation support, >10 years of service, urban practice, emergency medicine certification, and male gender.ConclusionsScenarios involving poisoning were referred less often when compared with an ideal scenario. Because poisoning is not a contraindication for referral, this represents a potential source of donors. Targeted training and referral support may help improve donation rates in this demographic.

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Increasing Referrals and Donations Using the Transplant Center Development Model

Journal of Transplant Coordination ◽

10.1177/090591999600600109 ◽

1996 ◽

Vol 6 (1) ◽

pp. 32-36 ◽

Cited By ~ 2

Author(s):

Mark T Gravel ◽

Penelope Szeman

Keyword(s):

Organ Donation ◽

Organ Procurement ◽

Medical Center ◽

Development Model ◽

Tissue Donation ◽

Staff Education ◽

Organ Procurement Organization ◽

Organ And Tissue Donation ◽

Transplant Center ◽

Donation Process

Although transplantation centers directly benefit from organ and tissue donation, they continue to yield low organ and tissue referral and donation rates. Our medical center and organ procurement organization developed a model to increase referral and donation rates. This model, called the Transplant Center Development Model, facilitates the donation process, specializes staff education, and promotes administrative involvement. After it was was implemented at our medical center in 1991, the referral and donation rates from 1988 to 1990 were compared with those from 1991 to 1993. The results showed that after implementation of the model, the organ referral mean increased 47%; the organ donation mean, 50%; and the tissue donation mean, 117%. These findings suggest that this model may be a valuable tool in transplant center development.

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Attitude and Information from Health Professionals Were Associated with Decision to Donate Organs among Arabic-Speaking Refugees: Exploring Opportunities for Intervention

Journal of Refugee Studies ◽

10.1093/jrs/feaa063 ◽

2020 ◽

Author(s):

Della Maneze ◽

Lucie Ramjan ◽

Naysan Rowhani-Farid ◽

Vilas Kovai ◽

Amin Gadalla ◽

...

Keyword(s):

Positive Attitude ◽

English Language ◽

Educational Interventions ◽

Survey Study ◽

Tissue Donation ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Language Acculturation ◽

Willingness To Donate ◽

Arabic Speaking

Abstract This cross-sectional survey study conducted between May and August 2017 on Arabic-speaking refugees resettled in Australia examined factors associated with willingness to donate organs. Of the 239 respondents, those who expressed greater willingness to donate organs and tissues were more likely to: (a) be Christians; (b) have obtained information from healthcare professionals (HCPs); (c) have higher organ and tissue donation (OTD) knowledge; (d) have a positive attitude towards OTD; and (e) have high English language acculturation levels. Nevertheless, after controlling for English language usage and religion, having a positive attitude towards OTD and receiving information from HCPs emerged as independent predictors of willingness to donate, underscoring the importance of educational interventions by HCPs

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P005: Regional anesthesia in Canadian emergency departments: Emergency physician practices and impressions

CJEM ◽

10.1017/cem.2020.213 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S66-S66

Author(s):

D. Wiercigroch ◽

S. Friedman ◽

D. Porplycia ◽

M. Ben-Yakov

Keyword(s):

Regional Anesthesia ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Emergency Physicians ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Physician Practices ◽

Canadian Association ◽

Modifiable Factors ◽

Barriers To Use

Introduction: The use of regional anesthesia (RA) by emergency physicians (EPs) is expanding in frequency and range of application as expertise in point-of-care ultrasound (POCUS) grows, but widespread use remains limited. We sought to characterize the use of RA by Canadian EPs, including practices, perspectives and barriers to use in the ED. Methods: A cross-sectional survey of Canadian EPs was administered to members of the Canadian Association of Emergency Physicians (CAEP), consisting of sixteen multiple choice and numerical responses. Responses were summarized descriptively as percentages and as the median and inter quartile range (IQR) for quantitative variables. Results: The survey was completed by 149/1144 staff EPs, with a response rate of 13%. EPs used RA a median of 2 (IQR 0-4) times in the past ten shifts. The most broadly used applications were soft tissue repair (84.5% of EPs, n = 126), fracture pain management (79.2%, n = 118) and orthopedic reduction (72.5%, n = 108). EPs agreed that RA is safe to use in the ED (98.7%) and were interested in using it more frequently (78.5%). Almost all (98.0%) respondents had POCUS available, however less than half (49.0%) felt comfortable using it for RA. EPs indicated that they required more training (76.5%), a departmental protocol (47.0%), and nursing assistance (30.2%) to increase their use. Conclusion: Canadian EPs engage in limited use of RA but express an interest in expanding their use. While equipment is available, additional training, protocols, and increased support from nursing staff are modifiable factors that could facilitate uptake of RA in the ED.

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P049: Post-intubation sedation in the emergency department: a survey of national practice patterns

CJEM ◽

10.1017/cem.2019.240 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S80

Author(s):

S. Freeman ◽

M. Columbus ◽

T. Nguyen ◽

S. Mal ◽

J. Yan

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Respiratory Failure ◽

Improve Patient Safety ◽

Teaching Hospitals ◽

Emergency Physicians ◽

Cross Sectional ◽

Canadian Association ◽

Clinical Scenarios ◽

Post Intubation

Introduction: Endotracheal intubation (ETI) is a lifesaving procedure commonly performed by emergency department (ED) physicians that may lead to patient discomfort or adverse events (e.g., unintended extubation) if sedation is inadequate. No ED-based sedation guidelines currently exist, so individual practice varies widely. This study's objective was to describe the self-reported post-ETI sedation practice of Canadian adult ED physicians. Methods: An anonymous, cross-sectional, web-based survey featuring 7 common ED scenarios requiring ETI was distributed to adult ED physician members of the Canadian Association of Emergency Physicians (CAEP). Scenarios included post-cardiac arrest, hypercapnic and hypoxic respiratory failure, status epilepticus, polytrauma, traumatic brain injury, and toxicology. Participants indicated first and second choice of sedative medication following ETI, as well as bolus vs. infusion administration in each scenario. Data was presented by descriptive statistics. Results: 207 (response rate 16.8%) ED physicians responded to the survey. Emergency medicine training of respondents included CCFP-EM (47.0%), FRCPC (35.8%), and CCFP (13.9%). 51.0% of respondents work primarily in academic/teaching hospitals and 40.4% work in community teaching hospitals. On average, responding physicians report providing care for 4.9 ± 6.8 (mean ± SD) intubated adult patients per month for varying durations (39.2% for 1–2 hours, 27.8% for 2–4 hours, and 22.7% for ≤1 hour). Combining all clinical scenarios, propofol was the most frequently used medication for post-ETI sedation (38.0% of all responses) and was the most frequently used agent except for the post-cardiac arrest, polytrauma, and hypercapnic respiratory failure scenarios. Ketamine was used second most frequently (28.2%), with midazolam being third most common (14.5%). Post-ETI sedation was provided by > 98% of physicians in all situations except the post-cardiac arrest (26.1% indicating no sedation) and toxicology (15.5% indicating no sedation) scenarios. Sedation was provided by infusion in 74.6% of cases and bolus in 25.4%. Conclusion: Significant practice variability with respect to post-ETI sedation exists amongst Canadian emergency physicians. Future quality improvement studies should examine sedation provided in real clinical scenarios with a goal of establishing best sedation practices to improve patient safety and quality of care.

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Organ Donation Workshop – a Survey on Nurses’ Knowledge and Attitudes toward Organ and Tissue Donation in Iran

The International Journal of Artificial Organs ◽

10.1177/039139880903201005 ◽

2009 ◽

Vol 32 (10) ◽

pp. 739-744 ◽

Cited By ~ 9

Author(s):

Hamid Reza Aghayaw ◽

Babak Arjmand ◽

Seyed Hassan Emami-Razavi ◽

Ali Jafarian ◽

Ali Reza Shabanzadeh ◽

...

Keyword(s):

Organ Donation ◽

Tissue Donation ◽

Knowledge And Attitudes ◽

Organ And Tissue Donation ◽

Nurses Knowledge

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Donation Education for Medical Students: Enhancing the Link between Physicians and Procurement Professionals

Progress in Transplantation ◽

10.1177/152692480501500204 ◽

2005 ◽

Vol 15 (2) ◽

pp. 124-128 ◽

Cited By ~ 14

Author(s):

Christian C. Essman ◽

Daniel J. Lebovitz

Keyword(s):

Medical Students ◽

Organ Donation ◽

Ethical Issues ◽

Organ Procurement ◽

Tissue Donation ◽

Current Crisis ◽

Educational Approach ◽

Organ And Tissue Donation ◽

Donation Process ◽

Organ Procurement Organizations

Purpose Increasing healthcare professionals' knowledge about organ and tissue donation; the national mandates regarding referral compliance; and the effect on donors, donor families, and transplant recipients is a challenging task. Physicians not routinely involved in organ donation or transplantation are some of the most difficult professionals for organ procurement organizations to access. A course for medical students was developed to initiate the transfer of information, comfort, and familiarity with the organ and tissue donation process. Methods Discussions with a local medical school revealed that little organized education on organ and tissue donation existed. An elective course was developed consisting of 2-hour lectures, once a week for 6 weeks. Topics included an overview of tissue and organ donation, history and significance of the current crisis, determination of brain death and its role in organ donation, tissue donation, pretransplant and posttransplant processes, ethical issues, and the donor family and recipient experience. Results A thorough course proposal was presented to the medical school's Chairman of Surgery and Chairman of Transplantation. The proposal was approved for first- and second-year medical students. Conclusion Offering medical students a unique and comprehensive course may attract curious students who could become future champions for donation. This type of educational approach may significantly influence future interactions between physicians and organ procurement organizations. If more organ procurement organizations implement this type of program, the medical students' knowledge of donation will not only affect and benefit the local organ procurement organization's service area but other procurement organizations throughout the country as well.

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Intra-hospital organ and tissue donation coordination project: cost-effectiveness and social benefits

Revista de Saúde Pública ◽

10.1590/s0034-8910.2015049005770 ◽

2015 ◽

Vol 49 (0) ◽

Author(s):

Vanessa Silva e Silva ◽

Luciana Carvalho Moura ◽

Renata Fabiana Leite ◽

Priscilla Caroliny de Oliveira ◽

Janine Schirmer ◽

...

Keyword(s):

Brain Death ◽

Cost Effective ◽

Cross Sectional Study ◽

Economic Research ◽

Tissue Donation ◽

Southeastern Brazil ◽

Hourly Wage ◽

Cross Sectional ◽

Organ And Tissue Donation ◽

Public Policy Implementation

OBJECTIVE To evaluate the viability of a professional specialist in intra-hospital committees of organ and tissue donation for transplantation. METHODS Epidemiological, retrospective and cross-sectional study (2003-2011 and 2008-2012), which was performed using organ donation for transplants data in the state of Sao Paulo, Southeastern Brazil. Nine hospitals were evaluated (hospitals 1 to 9). Logistic regression was used to evaluate the differences in the number of brain death referrals and actual donors (dependent variables) after the professional specialist started work (independent variable) at the intra-hospital committee of organ and tissue donation for transplantation. To evaluate the hospital invoicing, the hourly wage of the doctor and registered nurse, according to the legislation of the Consolidation of Labor Laws, were calculated, as were the investment return and the time elapsed to do so. RESULTS Following the nursing specialist commencement on the committee, brain death referrals and the number of actual donors increased at hospital 2 (4.17 and 1.52, respectively). At hospital 7, the number of actual donors also increased from 0.005 to 1.54. In addition, after the nurse started working, hospital revenues increased by 190.0% (ranging 40.0% to 1.955%). The monthly cost for the nurse working 20 hours was US$397.97 while the doctor would cost US$3,526.67. The return on investment was 275% over the short term (0.36 years). CONCLUSIONS This paper showed that including a professional specialist in intra-hospital committees for organ and tissue donation for transplantation proved to be cost-effective. Further economic research in the area could contribute to the efficient public policy implementation of this organ and tissue harvesting model.

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DOAÇÃO DE ÓRGÃOS E TECIDOS PARA TRANSPLANTES: motivos de não autorização

Cadernos de Pesquisa ◽

10.18764/2178-2229.v20n3p93-100 ◽

2013 ◽

Vol 20 (3) ◽

pp. 93

Author(s):

Flaviana de Souza Marques ◽

Maria das Dores Perpétua Barbosa ◽

Ivete Maria Ribeiro

Keyword(s):

Organ Donation ◽

Tissue Donation ◽

Santa Catarina ◽

Potential Donor ◽

Organ And Tissue Donation ◽

Calidad De Vida ◽

The Face ◽

Unrelated Donors

Trata-se de uma pesquisa documental, de abordagem qualitativa e quantitativa. Ela objetivou conhecer os motivos que levam o familiar a não autorizar a doação de órgãos. Esses registros foram feitos por uma equipe da Comissão Intra-Hospitalar de Doação de Órgãos e Tecidos para Transplantes de um hospital do sul de Santa Catarina. A coleta de dados foi realizada mediante um formulário com questões abertas e fechadas e registradas no próprio instrumento. Os sujeitos deste estudo foram os não doadores registrados nos formulários de notificação de potencial doador com coração parado e de morte encefálica, que fazem parte dos registros desta comissão. Os formulários analisados compreendem os anos de janeiro de 2011 até abril de 2013. De acordo com os registros da Comissão, a recusa familiar atingiu 135 casos, além de 21 casos específicos de que o paciente em vida não desejava ser doador. Portanto, a notificação incompleta impediu a classificação da recusa familiar neste estudo. Conhecer os fatores que dificultam a doação de órgãos poderá contribuir na dinâmica da equipe, uma vez que esta poderá atuar de maneira mais efetiva diante das negativas, elevando, desta forma, os índices de transplantes e melhorando a qua-lidade de vida dos indivíduos que estão à espera de um doador.Palavras-chave: Transplante de tecido. Transplante de órgãos. Triagem de doadores. Doadores não re-lacionados. ORGAN AND TISSUE DONATION FOR TRANSPLANTATION:reasons for non-authorizationAbstract: This is a documentary research, of a qualitative and quantitative approach. It aimed to identifythe reasons that lead family members not to allow organ donation. These records were made by an Intra-Hospital Commission on Organ and Tissue Donation for Transplantation team of a hospital in the south of Santa Catarina. The data collection was conducted using a form with open and closed questions and registered on the instrument itself. The subjects of this study were the non-donors registered in the notification forms of potential donor with cardiac arrest and brain death, which are part of the records of this committee. The forms analysed comprise the years from January 2011 to April 2013. According to the records of the Commission, refusal family reached 135 cases, and 21 specific cases that the patient in life didn’t want to be a donor. Therefore, underreporting prevented the classification of family refusal in this study. Knowing the factors that hinder organ donation can contribute to team dynamics, since it can act more effectively in the face of negatives, increasing, thus, the rates of transplantation and improving the quality of life of individuals who are waiting for a donor.Keywords: Tissue transplantation. Organ transplantation. Donor selection. Unrelated donors. DONACIÓN DE ÓRGANOS Y TEJIDOS PARA TRANSPLANTES:motivos de no autorizacionesResumen: Tratase de una investigación documental, de abordaje cualitativo y cuantitativo. Esta tiene como objetivo conocer los motivos que llevan al familiar a no autorizar la donación de órganos. Estos registrosfueron hechos por un equipo de la Comisión Intrahospitalaria de Donaciones de Órganos y Tejidos para Trasplantes de un hospital del sur de Santa Catarina. La colecta de datos fue realizada mediante preguntasabiertas, cerradas y registradas en el propio instrumento. Los sujetos de este estudio fueron los no donantes registrados en los formularios de notificación de donante potencial con corazón parado y de muerte encefálica, que hacen parte de los registros de esta comisión. Los formularios analizados comprendenlos años de enero de 2011 hasta abril de 2013. De acuerdo con los registros de la Comisión, la negativa familiar alcanzó el número de 135 casos, además de 21 casos específicos en los que el paciente en vida no deseaba ser donante. Por lo tanto, la notificación incompleta impidió la clasificación de la negativa familiar en este estudio. Conocer los factores que dificultan la donación de órganos podrá contribuir en la dinámica del equipo, una vez que esta podrá actuar de manera más efectiva delante de las negativas, elevando, de esta forma, los índices de trasplantes y mejorando la calidad de vida de los individuos que están a la espera de un donante.Palabras clave: Trasplante Transplante de tejidos. Trasplante Transplante de órganos. Selección de donante. Donante no emparentado93

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A Gift of Generosity—An Explanation of Organ and Tissue Donation and Transplantation for Muslim Audiences

Religions ◽

10.3390/rel12100815 ◽

2021 ◽

Vol 12 (10) ◽

pp. 815

Author(s):

Mohammad Abdus Sayek Khan

Keyword(s):

Organ Donation ◽

Life Support ◽

Organ Donor ◽

Tissue Donation ◽

Loved One ◽

Organ And Tissue Donation ◽

Lack Of Information ◽

The Family ◽

End Stage

Diseased Organ and tissue donation and transplantation entails removing organ and tissues from someone (the donor) and transplanting them into another person (the recipient). Transplanting organs and tissues from one person hold the capacity to save or significantly improve the quality of life of multiple recipients. This is a rare opportunity for one to become an organ donor. In 2018, Australia had a population of 24.99 million. A total of 160,909 lives were lost that year; almost half of this death occurred in hospitals. However, a person may only be able to become a donor if their death occurs in a particular way and fulfils a defined set of special criteria—for example, while on the life support machine in an intensive care unit. Because of this, only 1211 people out of the large number of lives lost in 2018 were eligible to be potential organ donors. This is one of reasons we encourage everybody to consider the virtues of organ and tissue donation in any end-of-life discussion. Diseased organ donation occurs only when the clinician is certain that the person has died. The death is diagnosed by neurological criteria or by circulatory criteria which are discussed in detail in the article. This is an unconditional altruistic and non-commercial act. A large number of people are waiting on transplant list in Australia who are suffering from end stage organ failure; some of them will die waiting unless one receives an organ transplantation. Australians are known to be highly generous people. That is why 98% of Australian say ‘Yes’ to become an organ donor when they die. But in reality, only about 64% of families consent for organ donation on an average. There are widespread misconceptions and myths about this subject, mostly due to lack of information and knowledge. I have attempted to explain the steps of diseased organ donation in this article which, hopefully will be able to break some of those misconceptions. I have avoided to discuss living donation which is entirely a different subject. I have only touched on Islamic perspective of organ donation here as multiple Islamic scholars are going to shed lights here. We encourage everybody to ‘Discover’ the facts about organ and tissue donation, to make an informed ‘Decision’ and ‘Discuss’ this with the family. If the family knows the wishes of the loved one, it makes their decision-making process much easier during such a devastating and stressful time.

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