Are potential organ donors missed on general wards? A 6‐month audit of hospital deaths

Objective: To determine whether potential organ donors are being missed on general wards by the DonateLife Audit, which concentrates on patients dying in emergency departments and intensive care units. Design, setting and patients: Six‐month (1 July to 31 December 2012) retrospective audit of patient deaths in a 700‐bed metropolitan Australian tertiary referral and teaching hospital. Main outcome measure: Potential organ donor suitability as assessed by a panel of organ donation specialists. Results: In total, 427 patients died, including nine neonates (2.1%) who were not further assessed and 175 patients (41.0%) who were excluded on the basis of age contraindicating organ donation (≥ 80 years). Seventy‐eight (18.3%) were excluded on the basis of active cancer or palliative care for cancer and 143 (33.5%) were deemed otherwise not medically suitable. Twelve (2.8%) had been referred to the DonateLife team for consideration for organ donation. Ten (2.3%) were submitted for panel review, and of these only three were considered to have “potential to develop brain death within 24 hours”. These patients would have required mechanical ventilation if potential organ donation were to be realised. One additional potential candidate for donation after circulatory death was identified in the intensive care unit. Conclusion: We identified very few potential organ donors among patients who died outside the emergency department and intensive care unit. For these patients to have progressed to organ donation, medical interventions not in keeping with standard Australian practice would have been required. The DonateLife Audit appears to be a robust tool for identifying realistic potential organ donors.