Organ donation from intensive care units in England and Wales: two year confidential audit of deaths in intensive care.

OBJECTIVES

Quantify possible increases in cadaveric organ donation from intensive care units; identify major sources of regional variation.

DESIGN

Confidential audit of all deaths in intensive care units in England in 1989 and 1990 and in Wales in 1990.

SETTING

15 regional and special health authorities in England; Wales.

PATIENTS

24,023 audited deaths in England; 682 in Wales.

MAIN OUTCOME MEASURES

Solid organ and corneal donor rates per 100 deaths; solid organ donor rate per 100 confirmed brain stem deaths; regional variation in (a) whether brain stem death was possible diagnosis, (b) general medical contraindications to donation, (c) relatives' refusal.

RESULTS

Confirmed brain stem death accounted for 2389 (10%) audited deaths in England. In 438 (18%) there was a general medical contraindication to organ donation, and of 1829 (94%) families asked about donation, 557 (30%) refused. Data for England suggested that among potential donors the heart is suitable for transplantation in 65% of cases, the kidneys in 95%, the liver in 71%, the lungs in 31%, and the corneas in 92%. Reasons for any shortfall in achievement of transplantation varied with organ type. Solid organ and corneal donor rates per 100 deaths were 5.0 and 3.9 respectively in England and 4.3 and 2.1 respectively in Wales. The solid organ donor rate per 100 confirmed brain stem deaths was 50 in England and 41 in Wales.

CONCLUSIONS

A 20% increase in number of cadaveric kidney donors from intensive care could be achieved by prompt testing for brain stem death and a quarter reduction in relatives' refusals.