Recognition of potential organ donors: an audit in a university hospital ICU

Introduction

In Poland, in 2002, the number of organ donors per one million inhabitants was 12.68, and was 8.9% higher than in 2001 (11.64/million). But still many potential organ donors are missed. The objective of this study was to identify the major causes of missed donors in a university hospital (600 beds) with a busy neurosurgery ward.

Methods

The Barlicki University Hospital, with an eight-bed ICU, is located in the second biggest city in Poland, with one million population. As the second in the city the transplantology centre started in 2000. A retrospective audit of ICU documentation from 2000 to 2003 of patients with declared brain steam death was conducted. After collecting the information, a computerised Excel database was created.

Results

The mean age of potential organ donors was 44.1 (SD 12.2) years. The main cause of death is cerebrovascular accident (62.1–77.8%), second is head injury (14.8–34.5%), and third is brain hypoxia after cardiac arrest (3.4–14.3%). The number of actual donors increased (55.2–74.1%) and relative refusal decreased (54.5–18.5%). The number of medical contrindications for organ donation is low (3.6–17.2% of potential donors). Only in 2002 five ICU patients had the clinical symptoms of brain steam death complicated by cardiovascular failure and it was impossible to complete the required by law tests. Over 3 years, only one potential organ donor was transferred from another hospital to our centre for organ donation.

Discussion

The number of potential organ donors per million of population in Poland varies significantly from 0.5 to 34.1 (mean 12.68) depending on the region. The number of 27–29 potential organ donors per year in our hospital is satisfactory but it can be increased by involvement of patients with complicated brain steam death. The number of relative refusals in Poland decreased from 10.4% in 2001 to 7.6% in 2002. In our centre the decrease is more defined: from 54.5% in 2000 to 18.5% in 2003. This may be related to growing support of transplantology in society. From the beginning of transplantation in our centre we did not record refusal of the potential donor (given before death).

Conclusions

Changes in the Transplant Law allowing for organ donation in cases of cardiovascular failure or cardiac arrest may increase furthermore the number of organ donors. A discussion of whether the relatives should be asked for consent is required. There are still many small hospitals that do not cooperate with transplant centres. The involvement of this hospitals in an organ donation program is the major task for the coming years.