Assessment of Organ Donation Potential From Brain-Dead Donors in Polish Hospitals Using Quality Systems: System Of Donor Hospital Transplant Coordinators and Web-Tooled System of Monitoring Intensive Care Unit Deaths

Abstract

IntroductionIn 2010 Poltransplant organized a national network of donor hospital transplant coordinators involved in the recruitment of potential deceased organ donors. One of the employed coordinators’ tasks is monitoring donation potential at hospitals and reporting their results with the use of a tele-information tool www.koordynator.net. BackgroundThe aim of our study was to evaluate the organ donation potential at hospitals in 2018 based on the analysis of reports and on the comparison of these results with organ donation indicators elaborated within the European Commission project entitled Improving the Knowledge and Practices in Organ Donation (DOPKI). MethodsReports concerning deaths were applied to a retrospective analysis regarding a possibility to diagnose deaths according to neurologic criteria and to detect possible donations. In total, 1214 reports from 116 hospitals were delivered to the tele-information system during 2018. The analysis was made based on 840 full monthly reports from 70 hospitals. Numbers and indicators connected to the organ donation potential, both in the hospital and the intensive care unit (ICU) scales, have been calculated: numbers of beds and admissions, total number of deaths, deaths due to reasons frequently leading to death according to neurologic criteria, number of brain death diagnoses, and number of organ donations. ResultsIn the scales of hospital and ICU the studied indices showed the following: 1. distinctly lower ratios related to brain death determination in the total number of beds, admissions, deaths, and deaths with selected International Classification of Diseases and Related Health Problems (ICD) codes in comparison with DOPKI results and 2. distinctly higher ratio of donations in the total number of brain deaths confirmed (69%) in comparison with DOPKI (42%). ConclusionsBased on obtained data from respective hospitals, the analysis showed the following in comparison with data coming from international European study (DOPKI): 1. low frequency of brain death determination procedures in the total number of deaths in Polish hospitals and ICUs, probably also in cases where such mechanism of death has occurred (the discrepancy may reach 1974 cases per year) and 2. high percentage of donations in the total number of brain-dead persons (conversion index), which may be caused by successful authorization of donation and acceptance of risky donors and organs by transplant teams but (what is more probable) may be explained by the ICUs’ habit that procedures of brain death protocol is implemented only in cases when donation is expected.