A multidisciplinary approach on the emergency department to admit potential organ donors for end-of-life care to the intensive care unit

M. Witjes, A. Kotsopoulos, L. Otterspoor, I.H.F. Herold, K.S. Simons, K. Woittiez, J.J.A. Eijkenboom, J.G. van der Hoeven, W.F. Abdo

Thursday 15 march 2018

16:15 - 16:25h at Van Rijck/Ruys Zaal

Categories: Coördinatiesessie, Session (parallel)

Parallel session: Parallel session 10: Transplant coordination

Background

In 2014, we performed a cohort study (Witjes, et al. 2017) in which we found that initiation of end-of-life care in acute settings outside Intensive Care Units (ICUs) results in under-recognition of potential organ donors, particularly in patients with an acute devastating brain injury admitted to the emergency department (ED).

Methods

In a multicenter prospective intervention study, we implemented a novel multidisciplinary approach for organ donation in the ED of six hospitals in the Netherlands. This approach was used in patients admitted to the ED with a devastating brain injury. When the decision to withdraw life sustaining treatment was made in the ED in patients without contra indications for organ donation, an ICU admission for end-of-life care was considered. This was communicated accordingly with the family. Every ICU admission for end-of-life care was evaluated. Interviews were conducted with emergency physicians, neurologists and ICU physicians according to a standardized questionnaire. This standardized interview focused on medical decisions that were made and difficulties arising during hospitalization.

Results

From 1 January 2016 to November 2017 data were collected on the number of patients admitted to the ED with acute brain injury in six hospitals. In total, 50 potential organ donors were admitted to the ICU for end-of-life care. Donation was either requested in the ED (12%), ICU (78%), neurology department (4%), or donation was not requested (6%). Out of 48 donation requests, 26 families (51%) consented to donation. This led to 21 successful organ transplantations. In four of these 21 patients family consent was obtained to intubate them solely for the purpose of organ donation. The most important points raised during the interviews with professionals were: explaining the non-therapeutic ICU admission to the family, the location where donation should be requested (ED/ICU), suitability for organ donation and utility of ICU resources.

Conclusion

A close collaboration between the ED, neurology department and ICU is necessary and achievable in order not to miss potential organ donors in patients with acute brain injury with a futile prognosis on the ED.