Donor conversion rates depend on the assessment tools used in the evaluation of potential organ donors (original) (raw)
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Intensive Care Medicine, 2006
Objective: To obtain insight into the occurrence of brain death and the potential for brain dead and controlled non-heart-beating organ donors (CNHB) in patients with traumatic brain injury (TBI), subarachnoid haemorrhage (SAH) and intracerebral haemorrhage (ICH) in a large neurosurgical serving area (2.1 million inhabitants). Design: Retrospective analysis of data concerning patients with TBI, SAH and ICH who died during the course of ICU treatment during 1999-2003. Setting: A 16-bed neuro-intensive care unit. Patients: Patients with TBI, SAH or ICH who died during the course of ICU treatment. Measurements and results: The number of ICU deaths in patients with TBI, SAH and ICH declined from 111 in 1999 to 64 in 2003. In total, 476 deaths occurred. Of these, 177 patients were not included in the analysis. Two hundred ninety-nine (299) ventilated patients had two or more absent brainstem reflexes (ABSR) and a Glasgow Coma Score of 3-4 at the moment of treatment withdrawal and formed the potential for organ donation; 61 of these patients were treated until full brain death. Organs of 57 patients could be harvested. We analysed the reasons that organs were not procured in the 242 remaining patients. The most important reasons were family refusal (32%), medical contraindications (14%), and the treating physician not considering potential organ donation (20%). The missed potential is 162/299 (54%). Conclusions: The number of actual and potential organ donors is declining, but a considerable number of potential CNHB donors exists. Refusal by relatives is the most important reason for failure to procure organs.
Acta neurochirurgica, 2018
To analyze the organ donation action in population-based neurointensive care of acute aneurysmal subarachnoid hemorrhage (aSAH) and to seek factors that would improve the identification of potential organ donors (PODs) and increase the donor conversion rate (DCR) after aSAH. The Kuopio Intracranial Aneurysm Database, prospective since 1995, includes all aSAH patients admitted to the Kuopio University Hospital (KUH) from its defined Eastern Finnish catchment population. We analyzed 769 consecutive acute aSAH patients from 2005 to 2015, including their data from the Finnish Transplantation Unit and the national clinical registries. We analyzed PODs vs. actual donors among the 145 (19%) aSAH patients who died within 14 days of admission. Finland had implemented the national presumed consent (opt-out) within the study period in the end of 2010. We retrospectively identified 83 (57%) PODs while only 49 (34%) had become actual donors (total DCR 59%); the causes for non-donorship were 15/3...
Brain death: Epidemiology and quality control of solid organ donor generation
Transplantation Proceedings, 2004
Successful solid organ transplant programs need effective organ procurement systems. Evaluating and maintaining the quality of an organ procurement system requires multilevel institutional coordination as well as reliable information regarding potential donors. The objective of this study was to analyze the potential to generate adult solid organ donors at a countrywide level as well as at individual hospital levels in Uruguay from 2000 to 2002. The analyzed factors included: encephalic deaths (brain deaths) officially registered by the National Bank of Organs and Tissues (BNOT), the distribution of these individuals among the intensive care units (ICUs) located at various hospitals, the number of Real Donors at each hospital, and the relation between the brain deaths and the number of ICU beds equipped with artificial respirators. The Uruguayan solid organ donation rate is relatively high among Latin American Countries, but low in relation to developed countries. The conversion of potential donors to actual donors is similar to that seen in developed countries. However, the registered incidence of brain deaths in relation to the number of ICU beds is surprisingly below the recognized standard figure. To approach the reasons for this difference, efficient quality control mechanisms are needed in the various ICUs as well as comprehensive medical case history reviews of all patient records.
Trends in brain-dead organ donor characteristics: a 13-year analysis
Canadian journal of surgery. Journal canadien de chirurgie, 2016
Driven by disease trends, such as obesity and metabolic syndrome, that are increasingly prevalent in the general population, we aimed to evaluate the comorbidities and attributes of the brain-dead organ donor population over time in a longitudinal study. We compared overall health and baseline attributes of organ donors between 2000-2005 and 2006-2012 using our prospective transplant database. Descriptive and comparative analyses of the 2 historical cohorts were performed. A total of 1040 brain-dead organ donors were included in our analysis: 496 from the 2000-2005 period and 544 from the 2006-2012 period. Our analysis revealed that donors from the recent (2006-2012) period were more likely to have increased body mass index (26.4 ± 6.0 v. 25.0 ± 4.8, p = 0.003), smoking history (57.0% v. 27.2%, p < 0.001), coronary artery disease (14.3% v. 3.2%, p = 0.015) and dyslipidemia (19.1% v. 4.2%, p < 0.001), but less likely to have concurrent infection (1.1% v. 7.9%, p < 0.001) tha...
Lost potential of kidney and liver donors amongst deceased intracerebral hemorrhage patients
European Journal of Neurology, 2014
Background and purpose: Intracerebral hemorrhage (ICH) has high acute mortality. The number of potential kidney and liver donors amongst deceased ICH patients was estimated to improve our institutional guidelines on acute care of neurocritical patients to increase organ donation. Methods: A chart review was carried out by a multi-professional team for consecutive ICH patients admitted to the emergency department at Helsinki University Central Hospital and dying within 14 days between 2005 and 2010. Results: In all, 955 patients had follow-up data, of whom 254 (27%) died within 14 days and eight ended up as organ donors. An additional 51 potentially suitable donors not different from actual donors were identified: nine suitable for kidney donation, 11 for liver and 31 for both. In 49/51 (96%) cases prognosis seemed nonexistent and do-not-resuscitate orders were issued early, which led to refrainment from intensive care in 76.5%. These potential donors differed from those ICH patients surviving a whole year (n = 529) by male preponderance, more severe symptoms (median National Institutes of Health Stroke Scale 25 vs. 6 and Glasgow Coma Scale 7 vs. 15), larger hematoma volumes of 24.8 cm 3 (vs. 6.7), and frequent finding of midline shift and intraventricular rupture of the hemorrhage in admission brain CT. Based on the results, our guidelines were revised towards more active treatment including mechanical ventilation for neurocritical patients at the emergency department for at least 48 h, resulting in an increase in organ donations in 2012. Conclusions: A considerable number of ICH patients are potential organ donors if the evaluation takes place on arrival and organ donation is considered as part of usual end-of-life care.
Korean journal of transplantation, 2023
Background: Improving organ donation rates requires better detection of possible organ donors, which in turn necessitates identifying barriers preventing the identification of possible organ donors. The objectives of this study were to determine the actual rate of possible deceased organ donors among nonreferred cases and to identify barriers to their identification as possible donors. Methods: This retrospective observational study used 6 months of data collected from two intensive care units (ICUs). Possible organ donors were defined as patients with a Glasgow Coma Scale score <5 and evidence of severe neurological damage. Barriers that led to the nonidentification of these patients as possible organ donors were also identified. Results: Fifty-six of 819 patients admitted to the ICUs during the study period were detected as possible organ donors, representing a 6.83% possible organ donor detection rate. Nonclinical barriers to the identification of possible organ donors were found to be more significant than clinical barriers (55% vs. 45%, respectively). The most significant nonclinical barrier was an unknown reason, despite patients being medically suitable for deceased organ donation and fulfilling the criteria for possible organ donor classification. Unresolved sepsis was the main clinical barrier. Conclusions: The significant rate of unreferred possible deceased organ donors found in this study reveals the need to increase awareness and knowledge among clinicians of the proper detection of possible donors at an early stage to avoid the loss of possible deceased organ donors, and thereby increase the deceased organ donation rate in Malaysian hospitals.
Nonexploited potential for organ donation
Transplantation Proceedings, 2003
HE WORLD WIDE SHORTAGE of organ donors requires urgent measures to ensure that all suitable patients dying in critical care units (CCUs) are identified as potential donors and referred to organ procurement professionals. A variety of organizational initiatives to increase cadaveric donation have been developed at (inter-)national, regional, or local hospital levels. One such initiative is Donor Action (DA), an international collaboration that brings together the best expertise to help hospitals increase their donation performance through improved clinical practices. 1-3 Experience in Europe and the United States indicates that a consistent hospital donation protocol built on multidisciplinary consensus and team building can lead to a significant increase in donation. 4 -7 Such a protocol supports teamwork toward common goals: to identify all potential donors and provide optimal care for families. As an added value, it also cultivates a sense of institutional ownership of the donation process among hospitals and their CCUs. A part of the DA program is a "diagnostic review" that takes a systematic approach toward achieving quality assurance in the whole donation process by helping CCUs to identify when, where, and why potential donors are missed along the donation pathway. DA's diagnostic review provides baseline information on a CCU's donation performance and has three components: a medical record review (MRR), a hospital attitude survey (HAS), and a system database to analyze and report on collected findings. The program also provides improvement measures in modular format to fill gaps identified by the DA diagnostic review. These come as five "stand alone" DA modules that follow the donation pathway (donor identification, donor referral, family care and communication, donor maintenance and retrieval). This study presents an update of preintervention MRR data on the potential for donation collected from 12 countries, including Poland, along with figures illustrating the immediate and sustained impact of implementing DA on donation rates in centers were the program has been introduced.