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A Retrospective Study on Potential Organ Donation and Transplantation Opportunities in Alberta Emergency Rooms and Intensive Care Units
- Author / Creator
- Ewasiuk, Amanda N
Background: In patients with end stage organ failure, organ transplant is often the only life saving treatment. Unfortunately, worldwide, the number of organs needed for transplant far outnumber the number of organs available. This scarcity of organs has led to interest in methods of increasing organ donation (OD) globally, including identification and characterization of Potential Missed Donors (PMDs). Thus, we had three main aims in this retrospective, cross-sectional study: (1) Calculate the incidence of PMDs in Alberta in 2015, (2) Determine where potential donors are most likely to missed in terms of urban or rural hospital location as well as tertiary and non-tertiary centers, (3) to identify and describe common characteristics of PMDs as well as independent associations with PMD status.
Methods: We performed a retrospective chart audit of all deaths in Alberta, Canada that occurred between January 1, 2015 and December 31, 2015. In total, we collected information on 2682 deaths in Alberta from 16 hospitals. Univariate analysis was used to identify significant demographic and clinical differences between PMDs and Non-PMDs. Logistic regression was performed to identify significant independent association with categorization as a PMD.
Results: Of the 2682 deaths reviewed, 225 patients were identified as PMDs. Consequently, the incidence of PMD in Alberta in 2015 was 53.7 (95% CI 40.6, 70.5) per million population (pmp) in 2015. On average, PMDs were significantly younger than non-PMDs (47 years vs. 62 years, p=0.001) and were more likely to have a death diagnosis of anoxic encephalopathy (49% vs. 39%, p=0.04). PMDs, on average, also had a significantly lower Glasgow Coma Score (GCS) compared to Non-PMDs (3.69 (1.65) vs. 4.36 (2.05), p=0.001). More non-PMDs than PMDs died in an urban tertiary ICU (p=0.04). However, more PMDs than non-PMDs died in an urban non-tertiary ICU. Multivariable analysis revealed independent associations with both younger age (Odds ratio (OR)=0.96, 95% CI (0.94, 0.97), p=0.001) and lower GCS (OR=0.87, 95% CI (0.76, 0.10), p=0.04). Independent association with tertiary hospital of death was marginally significant (OR=0.59, 95% CI (0.33, 1.07), p=0.08).
Conclusions: There is a large cohort of potential donors currently being missed in Alberta hospitals. Better identification in this group could lead to higher donor yield. Younger patients with a GCS lower than 4 presenting in urban, non-tertiary ICUs, are most likely to be PMDs and future efforts and resources should be focused on early identification of patients meeting these criteria.
- Graduation date
- Fall 2018
- Type of Item
- Master of Science
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