Admission to ICU "solely for possible organ donation"-audit of current New Zealand practice

Admission of patients with likely fatal illness to ICU "solely for possible organ donation" has been a long-standing practice in New Zealand. This is advocated as a means of increasing the availability of organs for transplant. We sought to determine the extent and characteristics of current clinical practice.

We identified patients admitted "solely for possible organ donation" from a total of 2,686 patients who died in the 24 public hospital ICUs in New Zealand between 1 July 2017 and 30 June 2019. We determined their characteristics, resource utilisation and organ and tissue donation outcomes.

There were 49 patients (F26, M23; age range 9 days to 79 years, median 57 years, European 36, Māori 11, Pacific 1, Asian 1). On 26 occasions (57%) ICU admission was preceded by a "preliminary family discussion about donation". Eighteen of the 24 ICUs admitted at least one patient (range 1 to 13, median 2) over the two-year period. All 49 patients had evidence of catastrophic brain damage at the time of ICU admission; they used a total of 60 ICU days, including 15.5 days for one patient who was actively treated after spontaneous improvement. Death occurred between 5 minutes and 15 days, median 18.7 hours after ICU admission; all but one death occurred by 82 hours. Distribution of ICU stay was similar for the 20 patients who donated and for those 29 who did not. Brain death developed in 22 patients, 20 of whom donated 63 organs, 15% of the total 430 organs donated by all deceased donors over the period. Organs from 20 donors were transplanted into 58 recipients, 14% of the total 417 recipients of deceased-donor organs over the period. Nine of the 49 patients also donated tissues for transplantation.

There are already a small number of patients being admitted to ICUs in New Zealand "solely for possible organ donation", the majority following prior family discussion of donation. These patients occupy a small number of ICU bed-days and contribute ~15% of the deceased donation activity. Organ Donation New Zealand has developed and recently promulgated recommended best practice guidelines for clinicians in the ICU and emergency departments and is supporting expansion of the practice within the scope of these guidelines.