Solid organ donation from the emergency department - A systematic review

Area of Science:

• Medical Research
• Transplantation Science
• Emergency Medicine

Background:

• A critical shortage of organ donors exists, impacting patients awaiting transplantation.
• The emergency department (ED) plays a role in organ donation, but the extent and potential for missed opportunities are not fully understood.

Purpose of the Study:

• To quantify the percentage of successful organ donors originating from the ED.
• To identify instances of missed organ donation opportunities within the ED.
• To determine factors contributing to successful and missed organ donations in the ED setting.

Main Methods:

• Systematic review of EMBASE, MEDLINE, and CINAHL databases.
• Inclusion of primary research articles on adult organ donation (successful and missed).
• Independent article screening and quality assessment using PRISMA and STROBE guidelines.

Main Results:

• Emergency department patients accounted for 4%-50% of successful donors (neurologic determination of death) and 3.6%-8.9% (circulatory determination of death).
• Up to 84% of potential donors after neurologic determination of death and 46.2% after circulatory determination of death were missed in the ED, primarily due to failure to refer.
• Clinical heterogeneity prevented meta-analysis.

Conclusions:

• The ED is a significant source of both actual and missed organ donors.
• Missed donations often result from incorrect eligibility assumptions and a failure to initiate the referral process.
• ED healthcare professionals must be knowledgeable about institutional organ donation referral protocols to prevent missed opportunities.