Abstract
Purpose
Comparative organ donation rates are expressed per million population and by this measurement, Canada lags behind other countries. These estimates do not account for differing demographics and health patterns of populations which can result in different rates of death by neurological criteria and subsequent donation rates. We sought to measure directly the number of deaths by neurological criteria, the associated donation rates, and the reasons for the differences.
Methods
A prospective evaluation of deaths by neurological and cardiorespiratory criteria in the critical care areas of three major adult Canadian tertiary care centres over a seven month period was undertaken. Patients were assessed for eligibility for organ and tissue donation and ultimate disposition.
Results
Annualized rates of death by neurological criteria varied from 2.3%-7.5% (8.6-28 patients) of all deaths. Conversion to actual donors ranged from 20-86%, with family refusal rates accounting for most of this variation. There were only three cases of suspected death by neurological criteria where a complete examination was not performed.
Conclusions
There is substantial geographic variability in the rate of neurological death and actual organ donation rates in these Canadian tertiary care centres. These variations are principally related to regional differences in demographics of brain injury, referral patterns and donation consent rates, rather than lack of identification of potential donors.
Résumé
Objectif
Les taux comparatifs de don d’organe sont donnés par million d’individus et, suivant cette mesure, le taux canadien est inférieur à celui d’autres pays. Ces taux n’expliquent pas la variété des données démographiques et des modèles de soins des populations pouvant fournir différents taux de mort neurologique et de don subséquent. Nous voulions évaluer directement le nombre de morts neurologiques, les taux de don associé et les raisons des différences.
Méthode
Une évaluation prospective des morts neurologiques et cardiorespiratoires, survenues au cours d’une période de sept mois dans trois grands centres tertiaires canadiens pour adultes, a été entreprise. Les patients ont été évalués en fonction de l’admissibilité au don d’organe et de tissu, et de leurs dernières volontés.
Résultats
Le taux de mort neurologique annualisé variait de 2,3 % - 7,5 % (8,6 - 28 patients) de tous les décès. La conversion des taux en donneurs réels allait de 20 à 86 %, le refus des familles comptant le plus dans cette variation. Il n’y a eu que trois cas de mort neurologique présumée où un examen complet n’avait pas été fait.
Conclusion
Le taux de mort neurologique et le taux réel de don d’organes varient beaucoup dans les centres canadiens étudiés. C’est surtout lié aux différences régionales de données démographiques sur les lésions cérébrales, de manières de diriger les patients vers les services et de taux de consentement au don plutôt qu’au défaut de reconnaître les donneurs potentiels.
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Competing interests: None declared. This work was supported in part by a peer-reviewed grant from Clarica (AJB, SB, JF, JS MK).
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Baker, A., Beed, S., Fenwick, J. et al. Number of deaths by neurological criteria, and organ and tissue donation rates at three critical care centres in Canada. Can J Anesth 53, 722–726 (2006). https://doi.org/10.1007/BF03021632
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DOI: https://doi.org/10.1007/BF03021632