Assessing Barriers to Organ and Tissue Donation in Australian Emergency Departments

Abstract

Introduction: Organ and tissue donation (OTD) rates in Australia depend on healthcare professionals assessing donor eligibility, referring eligible patients, and discussing donation with the next of kin (NOK). Historically, OTD has not been a focus of emergency departments (EDs), however a missed potential donor pool was identified in EDs. Additionally, international data suggest that referral of potential donors from the ED increases successful organ retrieval compared to inpatient units including the intensive care unit (ICU). In recent years, the Australian Government has directed resources to improve OTD rates from EDs, and a nationally consistent clinical trigger tool was introduced in EDs to assist with early identification of potential donors. However, ED clinicians' perceived barriers to OTD are unknown. Methods: We undertook a cross-sectional national survey of members of the Australasian Colleges of Emergency Medicine (ACEM) and Emergency Nursing (CENA) to assess barriers to OTD in the EDs of Australia. This online survey was informed by available literature and included part of the Hospital Attitude Survey (DonorAction) and a validated brain death knowledge test (Tawil, 2009). Results: The response rate was 20%, comprising 599 doctors and 212 nurses. 25% of respondents had not received any education on OTD, which is voluntary, with ED clinicians from certain cultural and religious background less likely to have received education. Most (75%) had at least one experience with OTD related tasks in the previous year. Despite the roll-out of the national clinical trigger in 2010, only 60% of staff were familiar with this, and most were unsure which medical conditions preclude donor eligibility. Shortage of time and ED and ICU overcrowding were the main resource barriers reported. Knowledge of brain death was poor with only 59% of doctors and 63% of nurses passing a validated test. Of those not passing the test, more than 50% felt comfortable, and competent to explain brain death to the NOK. Moreover, of the 20% of all respondents who had explained BD to the NOK in the previous year, more than 35% failed the BD test. Most (86%) respondents agreed that brain death was a valid determination of death, and 90% reported willingness to donate organs and tissues after own death. While 90% supported OTD in general, only 70% supported OTD after cardiac death. Most (77%) indicated a desire for further education, with OTD after cardiac death, clinical management of a donor, and brain death the main topics of interest. Conclusion: The results of this survey present a comprehensive current overview of ED clinicians' perceived barriers to OTD organized from the ED. Our study raises concerns about the lack of knowledge about brain death, and lack of awareness of this deficit. To increase OTD referred from the ED, we propose that the topics identified in this study are included in ED postgraduate curricula. An increase in knowledge is likely to positively affect ED clinicians' attitudes, and increase potential donor referrals as well as family consent rates. This study was funded by the Australian Organ and Tissue Authority.