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Identification of potential organ donors of advanced age in EDs
Philippe Le Conte1, David Riochet, Laetitia Labastire
1Pôle Urgence, Centre Hospitalier Universitaire de Nantes, France. philippe.leconte@chu-nantes.fr
Insights
A significant number of potential organ donors, approximately 7%, were identified among patients dying from neurologic causes in emergency departments. This highlights the need for collaboration to maximize organ donation in critical care settings.
Area of Science:
- Medical Research
- Transplantation Medicine
- Emergency Medicine
Background:
- Organ transplantation faces a global shortage, necessitating strategies to expand the donor pool.
- Older potential donors, particularly those who die from stroke, are increasingly considered.
Purpose of the Study:
- To identify potential organ donors with preserved cardiac function among patients dying in emergency departments.
- To assess the prevalence and characteristics of potential organ donors in this critical care setting.
Main Methods:
- A post hoc analysis of a multicenter prospective observational study was conducted.
- Patients who died of a neurologic cause without contraindications for donation were identified.
- Data on patient demographics, clinical status, and time to death were analyzed.
Main Results:
- Out of 2420 patients, 174 (7.2%) were identified as potential organ donors.
- The mean age of potential donors was 75.2 years; 39% were intubated, and 34.5% were mechanically ventilated.
- Over half of potential donors died within 12 hours of admission, and 7% died while receiving maximal care.
Conclusions:
- A notable percentage of patients dying in emergency departments, particularly older individuals with neurologic conditions, can be considered potential organ donors.
- Family opposition can significantly reduce the number of actual donors.
- Collaboration between emergency physicians, intensive care units, and organ donation teams is crucial to optimize end-of-life care and increase organ procurement.
Objective:
In France and in Belgium, as in many countries, there is a shortage of organs for transplantation, which has led to strategies to recruit older potential donors who may die of stroke.
Methods:
We conducted a post hoc analysis to identify potential organ donors with cardiac function among a population of dying patients in emergency departments. This population had been selected for a separate multicenter prospective observational study. We identified patients who died of a neurologic cause but had no clinical findings affecting their donor status.
Results:
Of 2420 patients in the study, 407 died of a neurologic cause; and 233 of these were excluded because of clinical factors that made them ineligible as organ donors. The remaining 174 patients (7.2% of dying patients) could be considered potential organ donors. Their mean age was 75.2 ± 11 years. Sixty-eight (39%) were intubated, and 60 of these (34.5%) were mechanically ventilated. In addition, 94 patients (54%) died within 12 hours (median, 9.3 hours) after admission; and 13 (7%) died while receiving a maximum level of care. No diagnostic procedures were performed to assess brain death.
Conclusion:
A significant number of patients who die in emergency departments could be organ donors, including approximately 7% between 60 and 85 years of age with life-threatening neurologic diseases. However, this percentage may be reduced by family opposition. Emergency physicians should collaborate with intensive care units and local organ donation teams to optimize end-of-life care and maximize the number of potential donors.
