LO66: Solid organ donation from the emergency department: A death review

Introduction: A significant gap exists between the number of people waiting for an organ and donors. There are currently 1,628 people awaiting organ donation in Ontario alone. In 2018 to date, 310 donors have donated 858 organs. The purpose of this study was to determine whether there were missed donors in the Emergency Department (ED) and by what percent those missed donors would increase organ donation overall. Methods: This was a health records and organ donation database review of all patients who died in the ED at a large academic tertiary care center with 2 campuses and 160,000 visits per year. Patients were included from November 1, 2014 – October 31, 2017. We collected data on demographics, cause of death, and suitability for organ donation. Data was cross-referenced between hospital records and the provincial organ procurement organization called Trillium Gift of Life Network (TGLN) to determine whether patients were appropriately referred for consideration of donation in a timely manner. Potential missed donors were manually screened for suitability according to TGLN criteria. We calculated simple descriptive statistics for demographic data and the primary outcome. The primary outcome was percentage of potential organ donors missed in the Emergency Department (ED). Results: There were 606 deaths in the ED from November 1, 2014 – October 31, 2017. Patients were an average of 71 years old, 353 (58%) were male, and 75 (12%) died of a traumatic cause. TGLN was not contacted in 12 (2%) of cases. During this period there were two donors from the ED and 92 from the ICU. There were ten missed potential donors. They were an average of 67 years, 7 (70%) were male, and 2 (20%) died of a traumatic cause. In all ten cases, patients had withdrawal of life sustaining measures for medical futility prior to TGLN being contacted for consideration of donation. There could have been an addition seven liver, six pancreatic islet, four small bowel, and seven kidney donors. The ten missed ED donors could have increased total donors by 11%. Conclusion: The ED is a significant source of missed organ donors. In all cases of missed organ donation, patients had withdrawal of life sustaining measures prior to TGLN being called. In the future, it is essential that all patients have an organ procurement organization such as TGLN called prior to withdrawal of life sustaining measures to ensure that no opportunity for consideration of organ donation is missed.

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Solid organ donation from the emergency department – missed donor opportunities

CJEM ◽

10.1017/cem.2019.482 ◽

2020 ◽

Vol 22 (5) ◽

pp. 701-707

Author(s):

Jessica McCallum ◽

Ryan Yip ◽

Sonny Dhanani ◽

Ian Stiell

Keyword(s):

Emergency Department ◽

Organ Donation ◽

Primary Outcome ◽

Solid Organ Transplantation ◽

Medical Futility ◽

Secondary Outcome ◽

Solid Organ ◽

Organ Donors ◽

Health Records ◽

Made In

ABSTRACTObjectiveA 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).MethodsWe 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.ResultsThere 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.ConclusionThe 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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P098: Solid organ donation from the emergency department - a systematic review

CJEM ◽

10.1017/cem.2018.296 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S91-S91

Author(s):

J. McCallum ◽

B. Ellis ◽

I. G. Stiell

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Organ Donation ◽

Cardiopulmonary Arrest ◽

Meta Analysis ◽

Organ Transplant ◽

Donation After Cardiac Death ◽

Solid Organ ◽

Organ Donors ◽

Human Adults

Introduction: There is a significant gap between the number of organ donors and people awaiting an organ transplant; therefore it is essential that all potential donors are identified. Given the nature of Emergency Medicine it is a potential source of organ donors. The purpose of this study is to determine what percent of successful donors come from the Emergency Department (ED) and whether there are any missed potential donors. Methods: Electronic searches of EMBASE, MEDLINE, and CINAHL were performed July 7, 2017 using PRISMA guidelines. Primary literature in human adults were included if they described identification of patients in the ED who went on to become successful solid organ donors, or described missed potential donors in the ED. Data on the total population of actual or missed donors was required to allow calculation of a percentage. Studies describing non-solid organ donation, consent, ethics, survey of attitudes, teaching curricula, procurement techniques, donation outside the ED, and recipient factors were excluded. 2 authors independently screened articles for inclusion and discrepancies were resolved through consensus. Quality was assessed using STROBE for observational studies. Heterogeneity of patient populations precluded pooling of the data to conduct a meta-analysis. Results: 1058 articles were identified, 17 duplicates were removed, 800 articles were excluded based on title and abstract, and 217 full text articles were excluded, yielding 24 articles for the systematic review. For neurologic determination of death (NDD), ED patients comprised 4 44% of successful donors. ED death reviews revealed 0 84% of patients dying in the ED are missed as potential donors and hospital-wide death reviews revealed 13 80.9% of missed donors die in the ED. For donation after cardiac death (DCD), 4 20% of successful donors came from the ED and studies investigating potential donors suggest 2 36% of patients dying the in the ED could be potential DCD donors. The most common population of successful DCD organ donors was in traumatic cardiopulmonary arrest (TCPA), with 3.6 8.9% of TCPA patients presenting to the ED becoming successful donors. Conclusion: Patients dying in the Emergency Department are a significant source of both successful organ donors and missed potential donors. Emergency physicians should be familiar with their local organ donation protocol to ensure potential organ donors are not missed.

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Patterns of Injury and Mortality in Pediatric Patients Attending Emergency Department in a Tertiary Care Center in Eastern Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.3096 ◽

2017 ◽

Vol 56 (207) ◽

pp. 331-334 ◽

Cited By ~ 3

Author(s):

Pramendra Prasad Gupta ◽

Gyanendra Bahadur Malla ◽

Rabin Bhandari ◽

Rosan Prasad Shah Kalawar ◽

Madan Mandal

Keyword(s):

Emergency Department ◽

Low Income ◽

Care Center ◽

Demographic Data ◽

Tertiary Care ◽

Soft Tissue Injuries ◽

Low Income Countries ◽

Health Concern ◽

Cross Sectional ◽

Pattern Of Injury

Introduction: Trauma is a major and increasing global health concern in the recent world is now the leading cause of death among people less than 18 years old. Methods: This is a retrospective cross sectional study done in Emergency Department of B.P.Koirala Institute of Health Sciences. Patients aged less than 16 years were included with history of Trauma from January 1st 2013 to 31st December 2013.The details of patient were taken from computerized medical records of the hospital. The data Demographic data, Pattern of injury, Mode of injury, Diagnosis and outcomes were tabulated in Microsoft excel. Results: Total 3958 pediatrics patient were enrolled in this study. Male: Female=3.6:1,Mean age 9.6±3.2 years, fall injury & RTAs common modes and fractures of limbs, soft tissue injuries and cut injuries were common patterns. Conclusions: Injury is a serious problem for children in Low Income countries like Nepal.

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Solid organ donation from the emergency department – A systematic review

CJEM ◽

10.1017/cem.2019.365 ◽

2019 ◽

Vol 21 (5) ◽

pp. 626-637 ◽

Cited By ~ 4

Author(s):

Jessica McCallum ◽

Brittany Ellis ◽

Sonny Dhanani ◽

Ian G. Stiell

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Organ Donation ◽

Meta Analysis ◽

Healthcare Team ◽

Solid Organ ◽

Organ Donors ◽

Determination Of Death ◽

Eligibility Criteria

ABSTRACTObjectivesA 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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An In-House Coordinator Program to Increase Organ Donation in Public Trauma Hospitals

Journal of Transplant Coordination ◽

10.1177/090591999800800205 ◽

1998 ◽

Vol 8 (2) ◽

pp. 82-87 ◽

Cited By ~ 6

Author(s):

Teresa Shafer ◽

R. Patrick Wood ◽

Charles Van Buren ◽

William Guerriero ◽

Kimberly Davis ◽

...

Keyword(s):

Retrospective Study ◽

Organ Donation ◽

Organ Procurement ◽

Consent Process ◽

Organ Donors ◽

Consent Rate ◽

Donor Management ◽

Organ Procurement Organization ◽

Conversion Rates ◽

Organ Recovery

A 4-year retrospective study was conducted regarding the donor potential, consent rates, and organ recovery at a large 500-bed public trauma hospital. An independent organ procurement organization hired two in-house coordinators, one white and one black, to work exclusively in the hospital. The duties of the in-house coordinators included the following: working with nurses, physicians, and residents to identify donors; closely managing and coordinating the consent process; and assisting organ procurement coordinators in donor management. Following the program's implementation and the use of race-specific requesters, a 64% increase in consent rate resulted along with an overall increase of 94% in the number of organ donors. The consent rate of blacks increased 115%, whereas the number of black organ donors increased 154%. The Hispanic consent rate increased 48% with a corresponding increase of 83% in the number of Hispanic organ donors. In addition, the white consent rate increased from 55% (the 3-year average from 1993 to 1995) to 75% in 1996, resulting in a 36% increase following the implementation of the program. The investment of dedicated race-sensitive personnel in large urban county trauma facilities can result in a significant increase in donor conversion rates.

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The Living Organ Donor as Patient

10.1093/oso/9780197618202.001.0001 ◽

2021 ◽

Author(s):

Lainie Friedman Ross ◽

J. Richard Thistlethwaite, Jr.

Keyword(s):

Organ Donation ◽

Organ Transplantation ◽

Living Donor ◽

Organ Procurement ◽

Well Being ◽

Living Donors ◽

Solid Organ ◽

Organ Donors ◽

Ethics Framework ◽

Special Obligations

This is a book about living solid organ donors as patients in their own right. This book is premised on the supposition that the field of living donor organ transplantation is ethical, even if some specific applications are not, eg, pre-mortem organ procurement of an imminently dying patient. When Joseph Murray performed the first successful living kidney donor transplant in 1954, he thought this would be a temporary stopgap. Today, however, the goal of adequate organ supply without living donors remains elusive. If anything, the supply:demand ratio is worse. In this book, a five-principle living donor ethics framework is developed and used to examine the ethical issues raised by living donor selection demographics, innovative attempts to increase living organ donation, and living donor decision-making and risk thresholds. This ethics framework uses the three principles of the Belmont Report modified to organ transplantation (respect for persons, beneficence, and justice) supplemented by the principles of vulnerability and of special relationships creating special obligations. The approach requires that the transplant community fully embraces living organ donors (and prospective living organ donors) as patients to whom special obligations are owed. Only when living organ donors are regarded as patients in their own right and have a living donor advocate team dedicated to their well-being can the moral boundaries of living solid organ donation be determined and realized. This book provides theoretical arguments and practice guidelines, complemented by case studies, to ensure that living donors are given the full respect and care they deserve.

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Introduction

10.1093/oso/9780197618202.003.0001 ◽

2021 ◽

pp. 3-21

Author(s):

Lainie Friedman ◽

J. Richard Thistlethwaite, Jr

Keyword(s):

Organ Donation ◽

Organ Transplantation ◽

Living Donor ◽

Organ Procurement ◽

Solid Organ ◽

Organ Donors ◽

Ethics Framework ◽

Do No Harm ◽

Dying Patient ◽

Donor Transplant

This is a book about living solid organ donors as patients in their own right. It is premised on the supposition that the field of living donor organ transplantation is ethical, even if some instantiations are not, eg, pre-mortem organ procurement of an imminently dying patient. In this chapter, the objection to living solid organ donation based on the obligation to do no harm is rejected because it ignores the fact that for many living donors, the benefits outweigh the harms. It is argued that the principle of respect for persons permits some living solid organ donation provided that both the donor and the recipient are treated as patients in their own right. This chapter then provides an outline for the rest of the book in which a five-principle living donor ethics framework is developed and applied to various living donor transplant proposals.

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The Role of the Organ Procurement Organization (DSO) in Coordinating Organ Donation in Germany and the Organ Donation Initiative Plan (Sponsor: Novartis Pharma GmbH, Nürnberg)

Therapieforum Transplant ◽

10.1055/a-1143-1465 ◽

2020 ◽

Vol 08 (01) ◽

pp. 20-23

Keyword(s):

Organ Donation ◽

Organ Procurement ◽

European Countries ◽

Organ Donors ◽

Organ Procurement Organization ◽

Deutsche Stiftung Organtransplantation ◽

Key Factor

AbstractOrgan donation in Germany started to decline in 2010 and dropped to a 20-year low of 797 organ donors in 2017. The rate of 9.7 organ donors per million population is far below donor rates in other European countries. The Deutsche Stiftung Organtransplantation (DSO, German Organ Procurement Organization) has been concerned about this development for many years and, in cooperation with German donor hospitals, has conducted extensive analyses to identify possible causes. While the causes are multifarious, the DSO sees the improvement of the identification and referral of potential organ donors in hospitals as a key factor in enhancing organ donation rates.

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Medical Trainee Continuity of Care Following Emergency Department Consultations in a Pediatric Hospital

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00018.1 ◽

2016 ◽

Vol 8 (1) ◽

pp. 33-38 ◽

Cited By ~ 1

Author(s):

Kim Bjorklund ◽

Emily A. Eismann ◽

Roger Cornwall

Keyword(s):

Emergency Department ◽

Continuity Of Care ◽

Broad Spectrum ◽

Medical Records ◽

Care Center ◽

Tertiary Care ◽

Well Being ◽

Tertiary Care Center ◽

Pediatric Hospital ◽

Medical Trainee

ABSTRACT Background The importance of continuity of care in training is widely recognized; however, a broad-spectrum assessment across all specialties has not been performed. Objective We assessed the continuity of care provided by trainees, following patient consultations in the emergency department (ED) across all specialties at a large pediatric tertiary care center. Methods Medical records were reviewed to identify patients seen in consultation by a resident or fellow trainee in the ED over a 1-year period, and to determine if the patient followed up with the same trainee for the same condition during the next 6 months. Results Resident and fellow trainees from 33 specialties participated in 3400 ED consultations. Approximately 50% (1718 of 3400) of the patients seen in consultation by a trainee in the ED followed up with the same specialty within 6 months, but only 4.1% (70 of 1718) followed up with the same trainee for the same condition. Trainee continuity of care ranged from 0% to 21% among specialties, where specialties with resident clinics (14.4%) have a greater continuity of care than specialties without resident clinics (2.7%, P < .001). Continuity of care did not differ between fellows (4.2%) and residents (4.0%, P = .87), but did differ between postgraduate years for residents (P < .001). Conclusions Trainee continuity of care for ED consultations was low across all specialties and levels of training. If continuity of care is important for patient well-being and trainee education, efforts to improve continuity for trainees must be undertaken.

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