Department of Emergency Medicine, University of Ottawa, Ottawa, ON.
Division of Critical Care, Department of Pediatrics, University of Ottawa, Ottawa, ON.
CJEM. 2019 Sep;21(5):626-637. doi: 10.1017/cem.2019.365.
A significant gap exists between people awaiting an organ transplant and organ donors. The purpose of this study was to determine what percent of successful donors come from the emergency department (ED), whether there are any missed donors, and to identify factors associated with successful and missed donation.
This systematic review used electronic searches of EMBASE, MEDLINE, and CINAHL according to PRISMA guidelines on July 7, 2017. We included primary literature in adults describing successful and missed organ donation. Two authors independently screened articles, and discrepancies were resolved through consensus. Quality was assessed using the STROBE checklist.
This systematic review identified 1,058 articles, and 25 articles were included. For neurologic determination of death, ED patients comprised 4%-50% of successful donors and 3.6%-8.9% of successful donors for donation after circulatory determination of death. ED death reviews revealed up to 84% of missed neurologic determination of death, and 46.2% of missed circulatory determination of death donors who died in the ED are missed due to a failure to refer for consideration of organ donation. Clinical heterogeneity precluded pooling of the data to conduct a meta-analysis.
The ED is a source of actual and missed donors. Potential donors are often missed due to incorrect assumptions regarding eligibility criteria and failure of the healthcare team to refer for consideration of donation. ED healthcare professionals should be aware of organ donation referral protocols at their institution to ensure that no organ donors are missed.
等待器官移植的患者和器官捐献者之间存在显著差距。本研究旨在确定有多少成功捐献者来自急诊科（ED），是否存在遗漏的捐献者，并确定与成功和遗漏捐献相关的因素。
本系统评价根据 PRISMA 指南，于 2017 年 7 月 7 日在 EMBASE、MEDLINE 和 CINAHL 上进行了电子检索。我们纳入了描述成功和遗漏器官捐献的成年人的原始文献。两位作者独立筛选文章，如果存在分歧则通过共识解决。使用 STROBE 清单评估质量。
本系统评价共确定了 1058 篇文章，其中 25 篇文章被纳入。对于神经判定死亡，ED 患者占成功捐献者的 4%-50%，而循环判定死亡的成功捐献者占 3.6%-8.9%。ED 死亡审查显示，高达 84%的神经判定死亡的潜在捐献者被遗漏，而 46.2%的 ED 死亡的循环判定死亡捐献者因未能转介考虑器官捐献而被遗漏。临床异质性排除了对数据进行荟萃分析的可能性。
ED 是实际和潜在捐献者的来源。由于对资格标准的错误假设以及医疗团队未能转介考虑捐献，潜在供体经常被遗漏。ED 医疗保健专业人员应了解其机构的器官捐献转介协议，以确保不遗漏任何器官捐献者。
