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Brain death diagnoses and evaluation of the number of potential organ donors in Québec hospitals

[Les diagnostics de mort encéphalique et l’évaluation du nombre de donneurs d’organes possibles dans les hôpitaux du Québec]

Réal Cloutier, MD^*,, Dana Baran, MD^,, Jean E. Morin, MD^*,¶, Raymond Dandavino, MD^||, Denis Marleau, MD^**, Alain Naud, MD, Robert Gagnon, MSc^* and Marc Billard, MD^*

^* From the Transplantation Committee, Québec College of Physicians Montréal;
Directeur conseil, Conseil en Immobilisation et management Inc., Montreal,
Internal Medicine and Nephrology, McGill University Health Centre, Montréal,
Québec-Transplant; Montréal;
^¶ Cardiothoracic Surgery, McGill University Health Centre, Montréal;
^|| Hôpital Maisonneuve-Rosemont, Montréal;
^** Centre hospitalier de l’Université de Montréal St-Luc, Montréal;
Centre hospitalier Universitaire de Québec, Québec City; Québec, Canada.

Address correspondence to: Dr. Réal Cloutier, Conseil en Immobilisation et Management Inc. 440, boul. René-Lévesque Ouest, bureau 1700, Montréal, Québec H2Z 1V7. Phone: 514-393-4563, ext. 326; Fax: 514-393-4598; E-mail: rcloutier{at}cim-conseil.qc.ca

Purpose: Faced with our inability to respond to the growing number of Quebec patients waiting for organ transplants, we sought to determine the number of potential organ donors (OD) in acute care hospitals.

Methods: A retrospective chart review of all acute care, in-hospital deaths in Quebec in the year 2000 was undertaken. Hospital record librarians provided statistics and completed questionnaires on each chart after applying exclusion and inclusion criteria.

Results: There were 24,702 acute care in-hospital deaths reported by 83 hospitals participating in the study on a voluntary basis. Analyzing 2,067 files meeting inclusion criteria, we identified 348 potential OD (1.4% of deaths). In hospitals not providing tertiary adult trauma care, the potential donor rate was 0.99% of all deaths. There were 4.5 times more potential donors in tertiary care adult trauma centers. Brain death was formally diagnosed in 268/348 patients, and organ donation discussed as an option with 230/268 families. Consent for donation was given in 70% of cases, although not all these patients proved to be suitable after evaluation. There were 125 actual donors in Quebec in the year 2000 (18 per million population).

Conclusions: The gap between used and potential donors can be explained by several factors including failure to approach families for organ donation, family refusal, incomplete neurological assessment of patients, and medical unsuitability of some consented donors. There is room for improvement in the identification of potential donors and in the presentation of organ donation as an end of life option to families.

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