Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Dutch Transplant Foundation, Leiden, The Netherlands.
Transplantation. 2019 Nov;103(11):2359-2365. doi: 10.1097/TP.0000000000002701.
The aim of this study was to evaluate the implementation process of a multidisciplinary approach for potential organ donors in the emergency department (ED) in order to incorporate organ donation into their end-of-life care plans.
A new multidisciplinary approach was implemented in 6 hospitals in The Netherlands between January 2016 and January 2018. The approach was introduced during staff meetings in the ED, intensive care unit (ICU), and neurology department. When patients with a devastating brain injury had a futile prognosis in the ED, without contraindications for organ donation, an ICU admission was considered. Every ICU admission to incorporate organ donation into end-of-life care was systematically evaluated with the involved physicians using a standardized questionnaire.
In total, 55 potential organ donors were admitted to the ICU to incorporate organ donation into end-of-life care. Twenty-seven families consented to donation and 20 successful organ donations were performed. Twenty-nine percent of the total pool of organ donors in these hospitals were admitted to the ICU for organ donation.
Patients with a devastating brain injury and futile medical prognosis in the ED are an important proportion of the total number of donors. The implementation of a multidisciplinary approach is feasible and could lead to better identification of potential donors in the ED.
本研究旨在评估急诊（ED）中潜在器官捐献者的多学科方法的实施过程，以便将器官捐献纳入其临终关怀计划。
2016 年 1 月至 2018 年 1 月期间，荷兰的 6 家医院实施了一种新的多学科方法。该方法在 ED、重症监护病房（ICU）和神经科的员工会议上进行介绍。当 ED 中患有致命性脑损伤且预后无望的患者没有器官捐献禁忌证时，会考虑将其收入 ICU。对每例为将器官捐献纳入临终关怀而收入 ICU 的患者，相关医生均使用标准化问卷进行系统评估。
共有 55 名潜在器官捐献者被收入 ICU 以将器官捐献纳入临终关怀。27 个家庭同意捐献，20 例成功进行了器官捐献。这些医院器官捐献者总数中，有 29%是因器官捐献而收入 ICU。
ED 中患有致命性脑损伤且预后无望的患者是器官捐献者总数中的一个重要比例。多学科方法的实施是可行的，并能在 ED 更好地识别潜在的捐献者。
