Study of Potential Organ and Tissue Donation in the Emergency Room

ABSTRACT

BACKGROUND: It is well known that the final treatment for human organ failure is transplantation. However, in reality, the number of donors of organs is insufficient compared to the number of patients waiting for transplantation. Identification of potential organ and tissue donors is important to transplantation. The status of patients having a possibility for transplantation among the patients who visited the emergency room was reviewed, and the status of donations of organs after determination of brain death in the emergency room was reviewed. The present study was performed in order to seek methods of increasing the rate of procurement of organs. METHODS: The records of patients who visited the emergency medical center of the present hospital from January 1, 1998, to December 31, 1999, were retrospectively analyzed. The patients were classified into three groups by interviewing the doctors in charge. Group I were those who were determined to be dead upon arrival at the hospital, Group II were those who left the hospital because of death or who were hospitalized in an irrecoverable state, and Group III were those who were determined to have died during the treatment in the emergency room. RESULTS: The results of this study showed that the number of potential donors of organs among the total 33,783 patients who visited the emergency room during this time was 299 patients, including 91 patients in Group 1, 89 patients in Group 2, and 119 patients in Group 3. Among them, 137 patients were excluded as their ages were not proper, and 62 patients were excluded due to medically unsuitable diseases. The remaining 100 patients were understood to be potential organ-donating patients. Among them, 98 cases were lost as approach to transplantation was not accomplished, and only 2 cases were successful transplantations in the emergency room. The reasons for the deaths of the potential organ donors included 49 cases of trauma, 15 cases of cardiac disease, 8 cases of respiratory disease, 7 cases of cerebral vascular disease, and 11 other cases. CONCLUSION: Most patients that could be determined to be brain dead were lost without recognition of the possibility of transplantation. Although many potential organ-donating patients were seen, the actual rate of procurement of organs was very low. These results imply that it is necessary to have transplantation programs in emergency rooms in order to find patients with possible brain death and to raise the awareness and training of people engaged in medicine and of people in general. Increasing the rate of organ procurement requires that criteria for non-heart-beating donation be established and then applied in the emergency room, bearing in mind the possibility of transplantation from the time of initial treatment as serious patients. The criteria for predicting potential brain death should be prepared for prior to the determination of brain death, as presented by KONOS(Korean Network for Organ Sharing).