Estimación de potenciales donantes en muerte cardiocirculatoria en el Hospital General Universitario de Elche / Estimation of potential donors after cardiocirculatory death in Elche University General Hospital (Alicante, Spain)

OBJETIVO: Estimar el número y las características de potenciales donantes de órganos de personas fallecidas por muerte cardiocirculatoria. Diseño y ámbito: Estudio retrospectivo observacional de los fallecidos entre 15-65 años entre el 2006 y 2014 en el Hospital General Universitario de Elche. Intervención: Realización de análisis univariante y modelo predictivo de regresión logística binaria para discriminar los factores relacionados con la contraindicación para la donación. Variables de interés: Identificar los pacientes con contraindicaciones para la donación. RESULTADOS: De los 1.510 pacientes fallecidos se excluyeron 1.048 por criterios crónicos de exclusión, 86 por evolucionar a muerte encefálica y 20 por pérdidas. Se analizaron 356 pacientes en 2 grupos: 288 en donación en asistolia II y 68 en donación en asistolia III. Resultaron potenciales donantes en asistolia II 70 pacientes y 10 donantes en asistolia III, lo que podría incrementar la actividad de donación en 8-9 donantes/año. Los pacientes fallecieron en: UCI, reanimación, urgencias, medicina interna, digestivo y neurología. Resultaron variables protectoras frente a contraindicación para la donación: fallecer en urgencias, parada cardiorrespiratoria previa o durante el ingreso, la enfermedad cardiológica, respiratoria y neurológica como causa de ingreso. Fallecer en el servicio de medicina interna se asoció a un mayor riesgo de contraindicaciones para la donación. CONCLUSIONES: Poner en marcha un protocolo de donación en asistolia en nuestro hospital podría incrementar el potencial de donación en unos 8-9 donantes/año

OBJECTIVE: To evaluate the number and characteristics of potential organ donors among cardiocirculatory death cases. Design and setting: A retrospective observational study was made of individuals between 15-65 years of age who died in the period 2006-2014 in Elche University General Hospital (Alicante, Spain). Intervention: A univariate analysis and binary logistic regression predictive model were performed to discriminate factors related to donation contraindication. Variables of interest: Identification of patients with donation contraindication. RESULTS: Of the 1510 patients who died in the mentioned period, 1048 were excluded due to the application of exclusion criteria; 86 due to evolution towards brain death; and 20 due to losses. A total of 356 patients were analyzed, divided into two groups: 288 in non-heart beating donation II and 68 in non-heart beating donation III. Seventy patients were found to be potential non-heart beating donation II and 10 were found to be potential non-heart beating donation III, which could increase donation activity by 8-9 donors a year. The patients died in the ICU, Resuscitation, Emergency Care, Internal Medicine, Digestive Diseases and Neurology. The following protective factors against organ donation contraindication were identified: death in Emergency Care, cardiorespiratory arrest before or during admission, and heart, respiratory and neurological disease as the cause of admission. Death in Internal Medicine was associated to an increased risk of donation contraindication. CONCLUSIONS: Implementing a non-heart beating donation protocol in our hospital could increase the donation potential by 8-9 donors a year

Estimation of potential donors after cardiocirculatory death in Elche University General Hospital (Alicante, Spain). / Estimación de potenciales donantes en muerte cardiocirculatoria en el Hospital General Universitario de Elche.

OBJECTIVE: To evaluate the number and characteristics of potential organ donors among cardiocirculatory death cases. DESIGN AND SETTING: A retrospective observational study was made of individuals between 15-65 years of age who died in the period 2006-2014 in Elche University General Hospital (Alicante, Spain). INTERVENTION: A univariate analysis and binary logistic regression predictive model were performed to discriminate factors related to donation contraindication. VARIABLES OF INTEREST: Identification of patients with donation contraindication. RESULTS: Of the 1510 patients who died in the mentioned period, 1048 were excluded due to the application of exclusion criteria; 86 due to evolution towards brain death; and 20 due to losses. A total of 356 patients were analyzed, divided into two groups: 288 in non-heart beating donation II and 68 in non-heart beating donation III. Seventy patients were found to be potential non-heart beating donation II and 10 were found to be potential non-heart beating donation III, which could increase donation activity by 8-9 donors a year. The patients died in the ICU, Resuscitation, Emergency Care, Internal Medicine, Digestive Diseases and Neurology. The following protective factors against organ donation contraindication were identified: death in Emergency Care, cardiorespiratory arrest before or during admission, and heart, respiratory and neurological disease as the cause of admission. Death in Internal Medicine was associated to an increased risk of donation contraindication. CONCLUSIONS: Implementing a non-heart beating donation protocol in our hospital could increase the donation potential by 8-9 donors a year.

Benchmarking in the process of donation after brain death: a methodology to identify best performer hospitals.

A benchmarking approach was developed in Spain to identify and spread critical success factors in the process of donation after brain death. This paper describes the methodology to identify the best performer hospitals in the period 2003-2007 with 106 hospitals throughout the country participating in the project. The process of donation after brain death was structured into three phases: referral of possible donors after brain death (DBD) to critical care units (CCUs) from outside units, management of possible DBDs within the CCUs and obtaining consent for organ donation. Indicators to assess performance in each phase were constructed and the factors influencing these indicators were studied to ensure that comparable groups of hospitals could be established. Availability of neurosurgery and CCU resources had a positive impact on the referral of possible DBDs to CCUs and those hospitals with fewer annual potential DBDs more frequently achieved 100% consent rates. Hospitals were grouped into each subprocess according to influencing factors. Hospitals with the best results were identified for each phase and hospital group. The subsequent study of their practices will lead to the identification of critical factors for success, which implemented in an adapted way should fortunately lead to increasing organ availability.