539: ORGAN DONATION ON ECMO: A DESCRIPTIVE ANALYSIS OF AN ORGAN PROCUREMENT ORGANIZATION DATABASE

ObjectiveTo fill the evidence gap on the value of a single brain death (SBD) or dual brain death (DBD) examination by providing data on irreversibility of brain function, organ donation consent, and transplantation.MethodsTwelve-year tertiary hospital and organ procurement organization data on brain death (BD) were combined and outcomes, including consent rate for organ donation and organs recovered and transplanted after SBD and DBD, were compared after multiple adjustments for covariates.ResultsA total of 266 patients were declared BD, 122 after SBD and 144 after DBD. Time from event to BD declaration was longer by an average of 20.9 hours after DBD (p = 0.003). Seventy-five (73%) families of patients with SBD and 86 (72%) with DBD consented for organ donation (p = 0.79). The number of BD examinations was not a predictor for consent. No patient regained brain function during the periods following BD. Patients with SBD were more likely to have at least 1 lung transplanted (p = 0.031). The number of organs transplanted was associated with the number of examinations (β coefficient [95% confidence interval] −0.5 [−0.97 to −0.02]; p = 0.044), along with age (for 5-year increase, −0.36 [−0.43 to −0.29]; p < 0.001) and PaO2 level (for 10 mm Hg increase, 0.026 [0.008–0.044]; p = 0.005) and decreased as the elapsed time to BD declaration increased (p = 0.019).ConclusionsA single neurologic examination to determine BD is sufficient in patients with nonanoxic catastrophic brain injuries. A second examination is without additional yield in this group and its delay reduces the number of organs transplanted.

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

CJEM ◽

10.1017/cem.2019.109 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S31-S32

Author(s):

J. McCallum ◽

R. Yip ◽

S. Dhanani ◽

I. Stiell

Keyword(s):

Emergency Department ◽

Organ Donation ◽

Primary Outcome ◽

Organ Procurement ◽

Care Center ◽

Demographic Data ◽

Tertiary Care ◽

Solid Organ ◽

Organ Donors ◽

Organ Procurement Organization

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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Organ Donation, Brain Death and the Family: Valid Informed Consent

The Journal of Law Medicine & Ethics ◽

10.1111/jlme.12254 ◽

2015 ◽

Vol 43 (2) ◽

pp. 369-382 ◽

Cited By ~ 7

Author(s):

Ana S. Iltis

Keyword(s):

Informed Consent ◽

Brain Death ◽

Organ Donation ◽

Organ Procurement ◽

Organ Donor ◽

Public Understanding ◽

Organ Procurement Organization ◽

The Family ◽

Driver's License ◽

Brain Dead

In July 2013, parents in Ohio objected to their 21-year-old son becoming an organ donor. Elijah Smith was involved in an accident and pronounced dead using neurological criteria. The organ procurement organization (OPO) went to court and argued that because the young man was brain dead and because his driver's license indicated that he wished to be a donor, the court should allow them to use his organs. The mother argued that her son did not understand what he was signing when he signed his license and that his signature did not reflect an informed decision. The court disagreed with her, saying that he had indicated a wish to donate his organs and that no one but Elijah could revoke that wish. His organs were removed.Elijah's mother suspected that he did not understand what he was signing. She might have been right, given what we know about the process for obtaining permission for organ donation and the limited public understanding of brain death.

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Research to Practice: A National Consensus Conference

Progress in Transplantation ◽

10.1177/152692480501500410 ◽

2005 ◽

Vol 15 (4) ◽

pp. 379-384 ◽

Cited By ~ 3

Author(s):

Robert A. Metzger ◽

Gloria J. Taylor ◽

Lin J. McGaw ◽

Francis L. Delmonico ◽

Jeffrey M. Prottas ◽

...

Keyword(s):

Organ Donation ◽

Family Support ◽

Organ Procurement ◽

Daily Practice ◽

Consensus Conference ◽

Primary Role ◽

Early Referral ◽

Organ Procurement Organization ◽

Successful Model ◽

Donation Process

Purpose To gain consensus on aspects of the process of gaining consent for organ donation that should be mainstream daily practice. Methods A 3-day consensus conference of transplant professionals that provided a forum for research and innovative ideas about gaining consent for organ donation. Four work groups were assembled to address issues of gaining consent from organ and tissue donors: (1) demystifying first-person consent (donor authorization): is it a matter of law?, (2) recovery coordinators: getting from green to great, (3) maximizing the process: old views and new, and (4) donor family support: mother or smother? Results Participants reached a consensus about major consent-related practices, identified areas of practice variance, and defined topics in need of further research. Conclusions The conference participants agreed that (1) the primary role of the organ procurement organization is to recover organs for transplantation from deceased donors and to facilitate distribution of those organs to the appropriate recipients; (2) early referral of potential donors from the hospital to the organ procurement organization is desirable; (3) a score less than 5 on the Glasgow Coma Scale should initiate end-of-life discussions with family members; a procurement coordinator from the organ procurement organization who is physically housed within the hospital is the most successful model for accommodating early referral of potential donors and optimizing family support practices; and (3) a decedent's right to donate should take precedence in the donation process and such designation by the donor before death is irrevocable and does not require the consent or concurrence of any person after the donor's death.

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Assessment of National Organ Donation Rates and Organ Procurement Organization Metrics

JAMA Surgery ◽

10.1001/jamasurg.2020.5395 ◽

2020 ◽

Cited By ~ 1

Author(s):

Luke J. DeRoos ◽

Yuhang Zhou ◽

Wesley J. Marrero ◽

Elliot B. Tapper ◽

Christopher J. Sonnenday ◽

...

Keyword(s):

Organ Donation ◽

Organ Procurement ◽

Organ Procurement Organization

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Factors Influencing Organ Placement Efforts in Donors with Brain Tumors

Journal of Transplant Coordination ◽

10.1177/090591999600600110 ◽

1996 ◽

Vol 6 (1) ◽

pp. 37-38

Author(s):

David D Lewis ◽

Robin R Vidovich ◽

LifeBanc Cleveland

Keyword(s):

Brain Tumor ◽

Brain Tumors ◽

Organ Donation ◽

Retrospective Review ◽

Organ Procurement ◽

Organ Procurement Organization ◽

Tissue Diagnosis ◽

Factors Influencing

A 3-year retrospective review of brain tumor cases was performed to determine factors that influence organ procurement in light of the increase in references in transplant literature to the hazards of transplanting organs from donors with brain tumors. A 3-year review of cases in which organ procurement efforts occurred were evaluated. Of 314 cases resulting from this review, organ procurement efforts yielded 10 patients with a diagnosis of brain tumor. Of those 10 cases, seven progressed to organ donation, with at least one organ per patient recovered. Manipulation of brain tumors or manipulation along with tissue diagnosis does not seem to hinder procurement of organs. Without tissue diagnosis, the ability of the organ procurement organization to place organs decreases significantly.

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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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