Quality assessment and outcomes related to deceased organ donation in a tertiary care hospital in India an observational study

Abstract

Background: We report quality assessment (QA) at each step of organ donation (OD), from the identification of a prospective donor with suspected brain death (BD) to organ retrieval. Methods: Case summaries and files of patients who expired or left against medical advice (LAMA) in 2019 in a 290-bed hospital were studied. Possible, potential, eligible, and actual donors were identified from among those with devastating brain injury (DBI). Potential donors (PDs) were subclassified into five types. The structure, process and outcomes related to OD were evaluated with appropriate Quality Indicators and Quality Criteria. Statistical Analysis: Data were analysed using MS Excel and we have used cross tabulation method for statistical analysis. Results: Of 352 deaths, 324 occurred in intensive care units (ICUs), of which 210 were reported from medical and surgical ICUs. ICD-10 codes relevant to process of OD were found in 27 patients, of whom 16 (7.6% of deaths) received ventilatory support and were possible donors. BD was suspected by ICU teams in 10 patients (4.7% of deaths), labeled as PDs. The presence of nonreactive pupils were recorded in 10 (100%) case files and 5 (50%) death summaries, while other brain stem reflexes were endorsed in 6 (60%) case files and none of death summaries. Rates for referral, contraindication, request, and consent were 80%, 40%, 66.6%, and 50%, respectively. From 20 patients with DBI who LAMA, 11 possible donors and five PDs were identified. Conclusion: Retrieval of data relevant to OD is possible by auditing the available mortality and LAMA records in India. Formatting of death summaries in patients with DBI to include Glasgow Coma Scale and all brain stem reflexes would help in the process of QA for OD.