Monitoring of organ donation potential from brain dead donors in Polish hospitals using web-tooled system of monitoring ICU deaths www.koordinator.net, taking into account the stratification of hospitals with the donation potential
Teresa Danek1, Klaudia Nestorowicz-Kałużna1, Marcin Macher1,2, Artur Kamiński1,2, Jarosław Czerwiński1,3.
1Polish Transplant Coordinating Center Poltransplant, Warsaw, Poland, Warszawa, Poland; 2Department of Transplantology and National Tissue and Cell Banking Center, Medical University of Warsaw, Poland, Warszawa, Poland; 3Department of Emergency Medicine, Medical University of Warsaw, Poland, Warszawa, Poland
Introduction: In order to be able to calculate the potential for organ donation from deceased donors in one hospital, region and country, it was necessary to develop a useful stratification system for all hospitals taking into account their characteristics in terms of having or not having wards crucial for donor identification and recruitment (ICU, Neurology, Neurosurgery), number of beds, patient profile (children vs adults).
Methods: There are 1032 hospitals in Poland, but only 388 have structural capabilities (minimum ICU and operating theatre). These hospitals with a potential for donation of the deceased were characterized according to the criteria presented above.
Results: The largest group were hospitals with ICU only for adults (161 hospitals), followed by hospitals with ICU and adult stroke units (76), hospitals for adults with ICUs with neurology department without stroke beds (25), hospitals for adults with ICU, stroke unit and neurosurgery. In the case of possible pediatric donation, the largest group were 5 hospitals with ICU departments for children, pediatric neurology and pediatric neurosurgery. The remaining hospitals were unique. In Poland, out of 388 hospitals with the potential to donate in terms of potential donors, only 120 hospitals were active (31%). ITUs in hospitals with a donation potential have 3,443 beds, including 327 beds in pediatric departments. Reports on deaths were retrospectively analyzed in terms of the possibility of diagnosing deaths according to neurological criteria and the detection of possible donations. In total, 1,116 reports from 105 hospitals were submitted to the ICT system in 2021. The donation potential analysis was carried out on the basis of 600 full monthly reports from 50 hospitals. Numbers and indices related to organ donation potential were calculated, both on the hospital and ICU scale: number of beds and admissions, total number of deaths, deaths from causes often fatal according to neurological criteria, number of brain death diagnoses and number of organ donors.
Conclusion: We treat the result of this study as fundamental for the calculation of the donation potential in Poland. Our thesis is that precisely characterized hospitals from the same group should have the same potential and should be active in the donation process on the same level. In hospital and ICU scales, the examined indicators showed: low frequency of brain death confirmation procedures in the total number of deaths in Polish hospitals, a high percentage of donations in the total number of dead brains, which may be due to the successful authorization of donation and the adoption of risky donors and organs by transplant teams, it may also be due to the fact that the procedures of the brain death protocol in Poland are used only in cases where organ donation is expected. It was possible to calculate the donation potential for individual groups of hospitals using the coordinator.net network tool.
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