Organ donation within the intensive care unit: A retrospective audit |
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| Affiliation: | 1. The Alfred Hospital Intensive Care Unit, Alfred Health, 55 Commercial Road Prahran, 3004, Victoria, Australia;2. School of Nursing and Midwifery, Faculty of Health, Deakin University, Locked Bag 2000, Geelong, Victoria, 3220, Australia;3. Centre for Quality and Patient Safety Research – Alfred Health Partnership, 55 Commercial Road Prahran, 3004, Victoria, Australia;4. Centre for Quality and Patient Safety Research – Monash Health Partnership, 246 Clayton road, Clayton, 3168, Victoria, Australia;1. Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia;2. Department of Physiotherapy, Royal Melbourne Hospital, Victoria, Australia;3. Pulmonary, Critical Care, Allergy and Immunology Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA;4. Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA;5. Section on Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, USA;6. Royal Free Hospital, NHS Foundation Trust, London, United Kingdom;7. Centre for Health and Human Performance, University College Hospital London, United Kingdom;8. Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Queensland, Australia;1. Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia, SA 5000;2. Discipline of Acute Care Medicine, Adelaide Health and Medical Sciences Building, 4 North Terrace, Adelaide, South Australia, Australia, SA 5000;3. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia, VIC 3800;4. Physiotherapy Department, The Alfred Hospital, 55 Commercial Rd, Melbourne, Australia, VIC 3004;5. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA;6. Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA;7. Intensive Care Unit, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia, VIC 3050;8. Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia, VIC 3050;1. Wound Centre, Södersjukhuset, 118 83 Stockholm, Sweden;2. Department of Clinical Science and Education, Karolinska Institutet Södersjukhuse, 118 83 Stockholm, Sweden;3. Copenhagen University Hospital, Rigshospitalet, Intensive Care Unit 4131, Blegdamsvej 9, 2100, Copenhagen, Denmark;4. University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark;5. Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden;6. Department of Orthopaedics, Sahlgrenska University Hospital/Mölndal, Gothenburg, Sweden;1. Nutrition & Dietetics Program, School of Life and Environmental Sciences, University of Sydney NSW 2006, Australia;2. Intensive Care Service, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia;3. Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia;1. School of Nursing & Midwifery, Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Australia;2. Disciplines of Nursing & Midwifery, Faculty of Health, University of Canberra, Australia;3. School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia;4. College of Medicine and Health Sciences, Australian National University, Australia;5. Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia;6. Intensive Care Services, Royal Brisbane and Women''s Hospital, Metro North Hospital Health Service, Queensland, Australia |
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| Abstract: | BackgroundDespite many Australians supporting organ donation, national posthumous organ donation rates have not increased as expected over the last three decades. Little is known about the barriers to organ donation for patients in intensive care that meet the criteria for organ donation.ObjectiveThe aim of this study was to describe the characteristics of patients identified as potentially suitable for organ donation and to explore the variables associated with the success, or failure, of solid organ donation within the context of an Australian public hospital intensive care unit (ICU).MethodsA retrospective audit examined electronic records of 280 potential organ donors aged 18–80 years, admitted into the ICU between 1 July 2012 and 30 June 2016. Data extracted from three separate electronic hospital databases were amalgamated for analysis.ResultsOf the 280 potential organ donors identified, conversations with families of 182 (65%) patients resulted in their agreement to organ donation. Consent to organ donation was most often provided by the patient's spouse (65, 35.7%); however, only 63.7% (n = 116) were successful organ donors. The remaining 36.3% (n = 66) of patients did not donate organs for medical reasons. Compared with those who did not donate, the typical organ donor was significantly younger (M 49.9 years, p = 0.020), Australian-born (p = 0.031), and had a shorter length of ICU stay (M 64.9 h, p = 0.002). The most frequently donated organs were kidneys (103, 88.8%), lungs (59, 50.9%), and livers (52, 44.8%).ConclusionThis study provided insights into patient, family, and organisational factors contributing to the success of organ donation outcomes in the ICU. Two factors that adversely impacted donation outcomes were the following: (1) the family did not consent to organ donation on behalf of the patient and (2) consent was provided, but donation did not proceed for medical reasons. Although the focus on the consenting process has been raised, this study highlights the additional impact of medical suitability on rates of organ donation. Family members may experience significant disappointment after consent that may have repercussions on their health and also future donation considerations. This study also highlighted some deficiencies in the databases that, if addressed, could better inform organisational processes in the consent and support of those making decisions about consent. |
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| Keywords: | Collaborative request Consent Critical care nursing Decision-making Family agreement Intensive care unit Organ donation Retrospective audit |
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