Authors (including presenting author) :
Lam SM (1), Tsoi CL (2), Shum HP (1), Yan WW (1)
Affiliation :
(1) Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
(2) Organ Donation Coordinator, Hong Kong East Cluster
Introduction :
Organ transplantation is frequently the only life‐saving treatment for patients with end‐stage organ failure. It improves recipients’ survival and quality of life and reduces cost compared to dialysis treatment. Transplantation treatment is limited by the chronic disparity between organs and the ever-increasing number awaiting transplantation. In Hong Kong, the number of deceased donors per million population (pmp) is low compared internationally (6 vs 10-34.4 pmp), and donation after brain death (BD) is the only pathway leading to organ donation. BD certification is thus a pre-requisite for successful donation.
In June 2020, the Department of Intensive Care, Pamela Youde Eastern Hospital (ICU) started a program to improve support for imminent BD patients in the general ward. Those with irreversible brain injury who were declined ICU admission because of futility were re-visited. For patients nearing BD, their families were interviewed for acceptance of futility and offered ICU support for BD certification.
Objectives :
To compare the percentages of missed opportunities and BD certification in possible organ donors before and after program implementation.
Methodology :
All cases identified by the organ donation coordinator from 1 January 2018 – 31 December 2019 (before) and 1 June 2020 – 30 November 2021 (after) were retrospectively reviewed. The percentages of missed opportunities and BD certification before and after were compared by χ2 test. A missed opportunity was defined as possible donors not tested for BD and without a valid reason (no family members, family unaccepting of futility or BD, hemodynamically unstable despite support, or persistent brainstem reflexes).
Result & Outcome :
Among a total of 96 patients, there were 48 in the before and 48 in the after group, with 38 and 44 considered possible donors respectively. Missed opportunities decreased significantly in the after group (7 (18.4%) vs 1 (2.3%), p=.01), leading to increased BD certification rate in the after group though not statistically significant (20 (52.6%) vs 28 (63.6%), p=.31).
Conclusions:
By revisiting futile patients with irreversible brain injury and increasing awareness of BD among staff, ICU significantly reduced the percentage of possible donors not considered for BD certification. This is an important first step to increase the number of deceased donors for successful transplantation.
