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Identifying the potential organ donor: an audit of hospital deaths

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Abstract

Objective

To quantify the potential for organ donation in Victoria and identify missed opportunities for organ donation.

Design and setting

Prospective medical record audit of all deaths in 12 Victorian hospitals.

Measurements

Data on deaths, total potential donors, organ donors and outcome of requests for organ donation were collected. Patients in whom brain death was confirmed or likely to occur and in whom organ donation was not requested (unrealised potential donors) were classified by an independent panel. Rates of organ donation and unrealised donors were determined as a proportion of total potential donors and hospital deaths and the maximal potential organ donor rate was estimated.

Results

Of 5551 deaths, there were 112 potential donors, with 66 requests for organ donation resulting in 39 consents (consent rate of 59%) and 37 organ donors (33% of total potential donors; 0.7% of hospital deaths). Two consented potential donors did not donate due to failed physiological support (5%). There were 46 medically suitable unrealised potential donors; 3 with confirmed brain death. Approximately half of these patients had treatment withdrawn in the intensive care unit and half in the Emergency Department. The estimated maximal potential donor rate was 30 per million population.

Conclusions

The potential for organ donation in Victoria is relatively low compared with previous estimates in Australia and overseas. An increase in the organ donation rate may be possible through increasing consent and the identification and support of potential donors. This would require substantial changes in clinical practice that have resource and ethical implications.

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Acknowledgements

This study was funded by the Department of Human Services and supported by the Australian and New Zealand Intensive Care Society (ANZICS). We especially acknowledge the support of the ANZICS executive members C. Scheinkestel, J. Presneill, C. French and G. Duke. We thank the auditors (G. Scully, L. Jager, A. Kakris and B. Dwyer) and panel members (A. Davies, C. French, B. Kelly, J. Presneill, J. Reeves and A. Vedig). We thank the Intensive Care departments and Medical Records of the following hospitals: Alfred Hospital; Austin and Repatriation Medical Centre; Bendigo Hospital; Box Hill Hospital; Epworth Hospital; Frankston Hospital; Geelong Hospital; Monash Medical Centre; Royal Children’s Hospital; Royal Melbourne Hospital; St. Vincent’s Hospital; and Western Hospital.

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Authors and Affiliations

  1. Department of Intensive Care, Austin Hospital, Studley Road, 3084, Heidelberg, Victoria, Australia

    Helen Ingrid Opdam & William Silvester

  2. Victorian Organ Donation Service, Melbourne, Australia

    Helen Ingrid Opdam & William Silvester

Authors
  1. Helen Ingrid Opdam
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  2. William Silvester
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Correspondence to Helen Ingrid Opdam.

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Opdam, H.I., Silvester, W. Identifying the potential organ donor: an audit of hospital deaths. Intensive Care Med 30, 1390–1397 (2004). https://doi.org/10.1007/s00134-004-2185-9

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