North Pacific Surgical Association
Emergency department referral for organ donation: more organ donors and more organs per donor

Presented at the 2013 Annual Meeting of the North Pacific Surgical Association, November 9, 2013, Victoria, British Columbia.
https://doi.org/10.1016/j.amjsurg.2013.12.017Get rights and content

Abstract

Background

This study sought to determine whether early referral from the emergency department (ED) would increase the number of organ donors and the number of organs transplanted per donor (OTPD).

Methods

This is a retrospective cohort analysis of all patients referred to a single organ procurement organization for a period of 60 months.

Results

Patients referred for organ donation evaluation from the ED were more likely to become organ donors than patients referred from the intensive care unit (19.3% vs 5.2%, P < .001). ED referrals had a greater number of OTPD than those referred from the intensive care unit (mean 3.79 vs 3.16, P = .024), even after adjusting for the higher proportion of ED referrals who were trauma patients (P = .001).

Conclusions

Referral for organ donation from the ED is associated with an increased likelihood of organ recovery and with an increased number of OTPD.

Section snippets

Methods

A retrospective cohort analysis was performed of all patients referred to a single OPO, Pacific Northwest Transplant Bank (PNTB), for a period of 60 months. PNTB's designated service area includes 81 hospitals in Oregon, southwest Washington, and southwest Idaho. The study population included all patients referred to PNTB for internal organ donation between July 1, 2007 and June 30, 2012.

PNTB's electronic databases were queried to identify the patient cohort and study variables. The analysis

Results

The cohort consisted of 7,437 patients with 243 patients referred from the ED and 7,194 referred from the ICU. Of the 7,437 patients referred, 557 (7.5%) were determined by PNTB to be medically suitable for donation and 420 (75.4% of potential donors, 5.6% of all referred patients) became internal organ donors.

The demographics of the patients referred from the ED did not differ from those referred from the ICU in age, sex, or race but did differ in injury type, as shown in Table 1.

Among all

Comments

Our findings validate other studies showing that ED-referred patients are more likely to become donors than ICU-referred patients. We also found that ED-referred patients have a greater number of OTPD than patients referred from the ICU, in what we believe to be the first study addressing this question. These findings underscore the importance of early referral in potentially increasing the number of transplantable organs available.

Centers for Medicaid and Medicare Services regulations require

Conclusions

Referral for organ donation from the ED is associated with an increased likelihood of organ recovery and with an increased number of OTPD. Referring patients from the ED is ethically appropriate and enables a timely decision about pursuing organ donation. Increasing the number of donors, and the number of transplantable organs, is of clinical and economic value to society; many life-years are saved through transplant, and many transplant recipients are able to return to work and contribute to

References (31)

  • P.R. Loubeau et al.

    The economics of kidney transplantation versus hemodialysis

    Prog Transplant

    (2001)
  • Organ Procurement and Transplantation Network Data. Available at: http://optn.transplant.hrsa.gov. Accessed August 5,...
  • Donation and Transplantation Community of Practice/DTCP. Available at http://organdonor.gov/dtcp/dtcp.html. Accessed...
  • G.E. Michael et al.

    The importance of emergency medicine in organ donation: successful donation is more likely when potential donors are referred from the emergency department

    Acad Emerg Med

    (2009)
  • P. Aubrey et al.

    The organ donor crisis: the missed organ donor potential from the accident and emergency departments

    Transplant Proc

    (2008)
  • M. Blackstock et al.

    Controlled organ donation after cardiac death: potential donors in the emergency department

    Transplantation

    (2010)
  • R.R. Riker et al.

    Organ and tissue donation from the emergency department

    J Emerg Med

    (1991)
  • P. Le Conte et al.

    Identification of potential organ donors of advanced age in EDs

    Am J Emerg Med

    (2012)
  • S.O. Henderson et al.

    Organ procurement in an urban level I emergency department

    Ann Emerg Med

    (1998)
  • R Core Team

    R: A Language and Environment for Statistical Computing

    (2013)

  • Medicare and Medicaid: hospital conditions of participation—identification of potential organ, tissue, and eye donors and transplant hospitals' provision of transplant-related data

    Fed Regist

    (1998)
  • R. Ehrle

    Timely referral of potential organ donors

    Crit Care Nurse

    (2006)
  • R. Stevens et al.

    Prognosis in severe brain injury

    Crit Care Med

    (2013)
  • A. Brody et al.

    Fatal gunshot wounds to the head: a critical appraisal of organ donation rates

    Am J Surg

    (2010)
  • C. Bruce et al.

    Are the public ready for organ donation after out of hospital cardiac arrest?

    Emerg Med J

    (2013)

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