Donation from the Emergency Department
Most organ donors die from catastrophic brain injury and have traditionally been identified and referred from
intensive care units. Rates of deceased organ donation in the UK are low when compared with many other developed
countries, and although this can be attributed in part to high levels of family refusal (for further details on
consent / authorisation for organ donation click here ), the number of potential deceased donors who are identified
and referred to the transplant coordination services is also relatively low. Although this could be attributable to
a lower intrinsic incidence of catastrophic brain injury, it seems more likely that it is a reflection of the nature
of end of life care offered to patients with such conditions – specifically, that aggressive treatments which are
considered to be of no overall benefit to a patient may be limited or withdrawn prior to admission to intensive care.
It seems likely that some of these decisions are made in Emergency Departments, and this has been confirmed by the UK Potential Donor Audit that was extended to deaths in the Emergency Department in April 2010. Furthermore, a number of pilot schemes have demonstrated that a small but important proportion of patients who die in Emergency Departments do have the potential for organ donation to be incorporated into their end of life care, with the number of deceased donors identified, referred and managed by Emergency Departments increasing steadily over recent years.
On most occasions fulfilling this potential requires not just the involvement of the transplant coordinator but also close collaboration between Emergency Medicine and critical care / theatre services. It is vital that hospitals have clear and comprehensive policies that define the roles and responsibilities of the key personnel / specialties involved, and that staff are aware of them. Local Donation Committees have an important role in ensuring that such policies are developed and implemented.