Thursday, September 21, 2023

Audit highlights missed opportunities in potential organ donations

Report makes numbers of recommendations to aid donation procedures

Opportunities to increase the number of potential donor organs were missed, a national clinical audit of organ donation practices has found.

Potential Donor Audit Development (PDA) Project Report collected data from six ICUs between November 2022 and February 2023. It found that, of the 231 people who died while in intensive care in these hospitals during this period, 23 died in circumstances where organ donation might have been possible. However, of these 23, just 13 went on to become organ donors.

Of the ten deceased patients where organs weren’t donated, it was found that three could not become organ donors due to medical events. There were five cases where ideal organ donation processes were not followed.

“While there is no guarantee that following ideal processes would have resulted in more donors, two to three of these cases might have resulted in donation had ideal processes been followed,” Dr Alan Gaffney, clinical lead for the Potential Donor Audit Development Project, said.

Of those families of eligible donors who were approached, 68 per cent agreed that it would have been their loved one’s wish to become an organ donor and consented to organ donation. This is consistent with international rates of family consent.

The report highlights areas of practice where improvements could lead to an increase in the numbers of people who could have become organ donors if that had been their wish. It also emphasises the feasibility of conducting a PDA in Irish hospitals and will inform any future national implementation of the audit.

The PDA development project made four key recommendations:

  • Implement the PDA nationally in all acute hospitals with ICUs and/or emergency departments.
  • Provide an agreed list of contraindications that can be operationalised for clinical practice to support the PDA.
  • Use the findings from the report to inform a set of national guidelines for organ donation.
  • Develop a clinically-led quality improvement forum for health professionals dedicated to improving organ donation and transplantation.

“Organ donation happens because of the generosity of people who die in our ICUs,” Dr Gaffney added. “It also happens because the healthcare system and those that work in it recognise the rare opportunities for organ donation that present themselves and manage the whole donation process in a professional and sensitive way. This audit shows how well the process is working in our ICUs but also identifies areas for improvement.

“Organ donation is such a rare event that any missed opportunity needs to be identified and learned from. By auditing our practice we can continue to modify how we work to reach our goal of offering organ donation to every person who dies in circumstances where organ donation is a possibility and where that would have been the person’s wishes.”

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