Organ donation by patients with and without trauma in a Canadian province: a retrospective cohort analysis

Lanteigne, Sara; Erdoğan, Mete; Hetherington, Alexandra; Cameron, Adam; Beed, Stephen; Green, Robert S.

doi:10.9778/cmajo.20180026

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…Canadian legislation regarding organ and tissue donation varies across provinces with only some legislating mandatory referral (four of the responding units). Old data from Canadian adults (2009–2016) and British children (2009–2014) both identify that, in the absence of mandatory referral, less than 50% of potential donors were referred to ODOs ( 23 , 24 ). Although in a U.S. study of 11,829 pediatric deaths (2008–2019), eligible deaths were less likely to be approached for consent if they lacked timely referral to the ODO ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021–2022*

Lee,

Martin,

Mahoney

et al. 2023

Pediatric Critical Care Medicine

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Objectives: To understand contemporary pediatric organ donation programs in Canadian PICUs, including: policies and practices, data collection and reporting, and system and process barriers. Design: A cross-sectional survey carried out 2021–2022. Setting: Canadian PICUs affiliated with a donor physician network. Subjects: Pediatric intensivists identified as the donation program lead, or most knowledgeable about donation for their institution. Measurements and Main Results: A 19-item survey was developed through collaboration with stakeholders from the organ donation and transplantation community within Canada. Domains and items were generated and reduced iteratively during an in-person workshop. Pretesting and pilot testing were completed to ensure readability, flow, clinical sensibility, and construct validity. Fifteen of 16 (94%) invited Canadian PICUs from seven provinces completed the survey representing 88% (15/18) of all noncardiac Canadian PICUs. Surveys were completed between June 2021 and September 2022. All units support donation after death by neurologic criteria (DNC); 14 of 15 indicated donation policies were in place and 1 of 15 indicated no policy but the ability to facilitate donation. Thirteen of 15 units (87%) support donation after death by circulatory criteria (DCC) with policies in place, with 11 of 13 of these indicating routine support of donation opportunities. The majority (13/15) of units identified a donation champion. Of the 16 identified champions across these centers, 13 were physicians and were registered nurses or nurse practitioners. Eight of 13 units (62%) with donation champions had positions supported financially, of which 5 units came from the Organ Donation Organization and the other 3 came from the provincial health authority. Finally, only 3 of 15 PICU donation programs have a pediatric donation committee with family involvement. Variability exists in identification (including determination of death practices), referral, and approach for donation between units. Conclusions: Although all Canadian PICUs support donation after DNC donation, and most support donation after DCC, variability exists in the identification, referral, and approach of potential donors. There is a notable lack of family involvement in pediatric donation programs. There are many opportunities for standardization of PICU donation programs which may result in improved rates of pediatric organ donation in Canada.

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Section: Discussionmentioning

confidence: 99%

Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021–2022*

Lee,

Martin,

Mahoney

et al. 2023

Pediatric Critical Care Medicine

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“…Failure to identify possible donors is the largest factor explaining differences in deceased donation rates across jurisdictions. 65 , 66 To maximize donation opportunities and ensure uniformity in how potential donors are evaluated, we recommend that, to the extent it is feasible to do so, dedicated protocols in end-of-life care be established to ensure that donation is considered for all individuals at the end-of-life.…”

Section: Methodsmentioning

confidence: 99%

“…They should focus on prognostic factors and should lead to referral regardless of a patient’s age or comorbidity even though few will ultimately be declared brain dead or eligible for DCD without contraindicated medical conditions. 65 …”

Section: Methodsmentioning

confidence: 99%

“…They should focus on prognostic factors and should lead to referral regardless of a patient's age or comorbidity even though few will ultimately be declared brain dead or eligible for DCD without contraindicated medical conditions. 65 Early and timely notification should be required, especially before interventions (like removal of mechanical ventilation) that might result in the inability to use the organs. It is important, however, to ensure that donation is only raised with families after a decision is reached to withdraw ventilation.…”

Section: Relevant Literature and Principlesmentioning

confidence: 99%

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Legislation and Policy Recommendations on Organ and Tissue Donation and Transplantation From an International Consensus Forum

Toews

Chandler

Pope

et al. 2023

Transplantation Direct

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Background. There is a shared global commitment to improving baseline donation and transplantation performance metrics in a manner consistent with ethics and local cultural and social factors. The law is one tool that can help improve these metrics. Although legal systems vary across jurisdictions, our objective was to create expert, consensus guidance for law and policymakers on foundational issues underlying organ and tissue donation and transplantation (OTDT) systems around the world. Methods. Using the nominal group technique, a group composed of legal academics, a transplant coordinator/clinician, and a patient partner identified topic areas and recommendations on foundational legal issues. The recommendations were informed by narrative literature reviews conducted by group members based on their areas of expertise, which yielded a range of academic articles, policy documents, and sources of law. Best practices were identified from relevant sources in each subtopic, which formed the basis of the recommendations contained herein. Results. We reached consensus on 12 recommendations grouped into 5 subtopics: (i) legal definitions and legislative scope, (ii) consent requirements for donation‚ (iii) allocation of organs and tissue‚ (iv) operation of OTDT systems‚ and (v) travel for transplant and organ trafficking. We have differentiated between those foundational legal principles for which there is a firm basis of support with those requiring further consideration and resolution. Seven such areas of controversy are identified and discussed alongside relevant recommendations. Conclusions. Our recommendations encompass some principles staunchly enshrined in the OTDT landscape (eg, the dead donor rule), whereas others reflect more recent developments in practice (eg, mandatory referral). Although some principles are widely accepted, there is not always consensus as to how they ought to be implemented. As the OTDT landscape continues to evolve, recommendations must be reconsidered for the law to keep pace with developments in knowledge, technology, and practice.

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Factors associated with organ donation by trauma patients in Nova Scotia

Hetherington¹,

Erdoğan

Cameron³

et al. 2019

J Trauma Acute Care Surg

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BACKGROUND Trauma patients represent a significant pool of potential organ donors (PODs), and previous research suggests that this population is underutilized for organ donation (OD). Our objective was to assess factors associated with OD in the trauma population. METHODS We retrospectively analyzed OD in Nova Scotia over a 7-year period (2009–2016) using data from the Nova Scotia Trauma Registry and Nova Scotia Legacy of Life Donor Registry. All trauma patients who died in the hospital were included. Multiple logistic regression was used to assess factors associated with donation. We also evaluated characteristics, donation types, and reasons for nondonation among trauma PODs. RESULTS There were 689 trauma-related deaths in all hospitals in NS during the study period, of which 39.8% (274 of 689) met the Nova Scotia Trauma Registry definition of a POD. Data on OD were available for 108 of these patients who were referred to the Legacy of Life Program. The conversion rate was 84%. Compared with nondonors, organ donors were significantly younger, had a higher Abbreviated Injury Scale head score and a lower scene Glasgow Coma Scale score, were more likely to suffer ischemia from drowning or asphyxia and to require air transport, and were less likely to have comorbidities. Regression analysis showed that donation was associated with younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95–0.99) and lower Glasgow Coma Scale score at the scene (OR, 0.76; 95% CI, 0.66–0.88). Odds of donation were increased with air transport compared with land ambulance (OR, 8.27; 95% CI, 2.07–33.08) and injury within Halifax Regional Municipality compared with injury outside Halifax Regional Municipality (OR, 4.64; 95% CI, 1.42–15.10). Among the 60 referred PODs who did not donate, family refusal of consent was the most common reason (28 [46.7%] of 60). CONCLUSION Younger age, greater severity of injury, and shorter time to tertiary care were associated with OD in trauma patients. LEVEL OF EVIDENCE Prognostic and Epidemiological, Level III.

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Organ donation by patients with and without trauma in a Canadian province: a retrospective cohort analysis

Abstract: In Nova Scotia, 40% of patients with trauma who died in hospital were potential organ donors, yet only 39% of these patients were referred for donation. More work is required to improve organ donation within the trauma population.

Cited by 3 publications

References 14 publications

Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021–2022*

Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021–2022*

Legislation and Policy Recommendations on Organ and Tissue Donation and Transplantation From an International Consensus Forum

Factors associated with organ donation by trauma patients in Nova Scotia

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