Need more organ donors? Look at emergency departments, says study

Missed opportunities for organ donation abound among patients with intracranial haemorrhage (ICH) at the emergency department (ED), reveals a Singapore study.

“EDs have an important role to play in the national organ donation programme by identifying potential donors for organ donation and considering admitting these patients to intensive care unit (ICU) to facilitate organ donation,” the researchers said.

This retrospective study involved all ICH patients presenting to the ED from 1 January 2013 to 31 December 2017. Medical records of these patients were reviewed for identification of potential donors and actualization of organ donation.

A total of 615 ICH patients were included, with a mortality rate of 6.0 percent. Twenty-eight (75.7 percent) of these died in the ICU and nine (24.3 percent) had withdrawal of care in the ED. [Proc Singapore Healthc 2020;28:274-279]

Thirty patients (81.8 percent) qualified as potential donors, but organ donation was actualized in only three patients (8.1 percent). Thirteen organs, as well as heart valves and iliac vessels, were recovered from these donors for transplantation.

To minimize these missed opportunities for organ donation, the researchers suggested certain strategies starting from the ED, “which is often the first contact point for potential donors.”

For instance, a multi-institutional ED review in North America reported that patients referred from the ED are more than threefold as likely than inpatients to donate organs and contribute a greater number or organs retrieved per donor. [Acad Emerg Med 2009;16:850-858; Am J Surg 2014;207:728-733]

“Therefore, referral for organ donation should be an established process within the EDs in Singapore,” the researchers said. “Patients who suffered neurological damage with Glasgow Coma Scale score of 3–4 and where end-of-life issues are being discussed with the next-of-kin should be referred to a transplant coordinator as potential donors.”

Another strategy proposed was intensive care admission to facilitate organ donation (ICOD). The Neurocritical Care Society (NCS) recommends that care should not be withdrawn in the ED for those with devastating brain injury and in whom early limitation of aggressive treatment is being considered.

These patients “should be admitted to the ICU for a period up to 72 hours to allow sufficient opportunity for end-of-life care planning and consideration of organ donation,” according to the NCS. [Neurocrit Care 2015;23:4-13]

“Rather than providing aggressive care directed at saving lives, ICOD will involve management strategies directed at organ preservation,” the researchers said. “ICOD has the potential to increase the pool of potential donors with organ donation being actualized 50–60 percent of the time.” [Med Intensiva 2017;41:162-173; Transplantation 2017;101:e265-e272; Crit Care Med 2017;45:e1050-e1059]

Of note, policies and protocols supported by available resource and adequate training must be established to improve the process of organ donation, according to the researchers.

“EDs will need to rise up to their instrumental roles in improving our national organ donation programme,” they added.