Extending the search for the missed potential organ donor: a six-month audit of deaths in a large Australian teaching hospital

Myra Sgorbini¹, Jonathan Gatward¹, Michael O'Leary¹

¹Intensive Care Service, Royal Prince Alfred Hospital, Sydney, Australia

The DonateLife Audit (DLA) is a review of all deaths that occurred in the Intensive Care Unit (ICU) and Emergency Department (ED) of selected New South Wales hospitals, and those who died due to an irrecoverable brain injury within 24 hours of leaving these areas, to measure organ donation (OD) activity. A 6 month retrospective audit of all in-hospital deaths was conducted at Sydney’s Royal Prince Alfred Hospital to establish whether potential organ donors were being missed by the DLA. Neonates and patients with oncological diagnosis, for palliative care, failed resuscitation in ED and over 80 years were excluded from a total number of 429 deaths. The remaining 119 deaths were subdivided by age: 65 years and under (41/119) and over 65 years (78/119). Three OD Specialists reviewed the deaths and found that nearly half of all deaths (58/119) and the majority of deaths under 65 years (31/41) occurred in ICU with only a small proportion dying in ED (6/119). Over 65s were deemed not medically suitable (NMS) if they had a non-neurological diagnosis (57/119). Of the 21 patients over 65 years with a neurological diagnosis, 12 were NMS, 1 was assessed for OD and 7 were set aside for further discussion. Of the 12 patients under 65 years with a neurological diagnosis, 3 were NMS and 9 were assessed for OD (resulting in 3 donors). Of 29 patients with a non-neurological diagnosis, 25 were NMS, 1 was assessed for OD and 2 were set aside for further discussion. The 9 identified patients were discussed at a multidisciplinary meeting of OD experts. It was decided that 1 ICU patient should have been considered for OD, but the remaining 8 patients would not have been considered for OD for various valid reasons.