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Organ and tissue donation from poisoned patients in the emergency department: A Canadian emergency physician survey

  • Louis Staple (a1), Janet MacIntyre (a2), Nancy G. Murphy (a2) (a3), Stephen Beed (a4) and Constance LeBlanc (a2)...

Abstract

Objectives

Screening for organ and tissue donation is an essential skill for emergency physicians. In 2015, 4,631 Canadians were on a waiting list for a transplant, and 262 died while waiting. Canada’s donation rates are less than half of comparable countries, so it is essential to explore strategies to improve the referral of donors. Poisoned patients may be one such underutilized source for donation. This study explores physician practices and perceptions regarding the referral of poisoned patients as donors.

Methods

In this cross-sectional unidirectional survey, 1,471 physician members of the Canadian Association of Emergency Physicians were invited to participate. Physicians were presented with 20 scenarios and asked whether they would refer the patient as a potential organ or tissue donor. Results were reported descriptively, and associations between demographics and referral patterns were assessed.

Results

Physicians totalling 208 participated in the organ or tissue donation scenarios (14.1%); 75% of scenarios involving poisoning were referred for organ or tissue donation, compared with 92% in a non-poisoning scenario. Poisons associated with lower referrals included sedatives, acetaminophen, chemical exposure, and organophosphates. A total of 175 physicians completed the demographic survey (11.9%). Characteristics associated with increased referrals included previous referral experience, donation training, donation support, >10 years of service, urban practice, emergency medicine certification, and male gender.

Conclusions

Scenarios involving poisoning were referred less often when compared with an ideal scenario. Because poisoning is not a contraindication for referral, this represents a potential source of donors. Targeted training and referral support may help improve donation rates in this demographic.

Objectif

Le dépistage des patients susceptibles de faire des dons d’organes ou de tissus est une compétence fondamentale des médecins d’urgence. En 2015, 4631 personnes au Canada étaient inscrites sur des listes d’attente en vue d’une transplantation et 262 d’entre elles sont mortes durant ce temps. Le taux de don au Canada est inférieur à la moitié de celui enregistré dans des pays comparables; il faut donc élaborer des stratégies permettant d’accroître le nombre de donneurs. Les patients qui succombent à une intoxication peuvent constituer un bassin sous-utilisé de dons. L’étude décrite ici porte sur les pratiques et les perceptions des médecins quant à l’admissibilité des patients décédés par intoxication à des dons d’organes ou de tissus.

Méthode

Il s’agit d’une enquête transversale, unidirectionnelle, menée parmi les membres de l’Association canadienne des médecins d’urgence (n=1471) invités à y participer. On leur a présenté 20 scénarios, et les médecins devaient indiquer s’ils considéraient les patients en question comme des donneurs potentiels d’organes ou de tissus. Les résultats sont exprimés sous forme descriptive, et des associations ont été établies entre les données démographiques et la pratique des demandes de dons d’organes.

Résultats

Au total, 208 médecins (14,1 %) ont indiqué leur choix dans les scénarios de dons d’organes ou de tissus. Une demande de dons a été faite dans 75% des scénarios comportant une intoxication contre 92% de ceux n’en comportant pas. Les substances associées à des taux inférieurs de demande de dons étaient les sédatifs, l’acétaminophène, les produits chimiques et les organophosphates. Cent soixante-quinze médecins (11,9%) ont rempli la section sur les données démographiques. Les caractéristiques associées à une demande accrue de dons comprenaient une expérience antérieure de ce type de demande, une formation sur les dons, du soutien en la matière, une expérience de travail supérieure à 10 ans, la pratique en milieu urbain, un certificat en médecine d’urgence et le sexe masculin.

Conclusions

Les scénarios comportant une intoxication ont fait moins souvent l’objet de demandes de dons d’organes ou de tissus que le scénario idéal. Comme les intoxications ne sont pas une contre-indication aux demandes de dons, les patients concernés constituent une source potentielle de donneurs. Ainsi, une formation ciblée sur le sujet et du soutien dans le processus de demande pourraient accroître le taux de don dans ce groupe de la population.

Copyright

Corresponding author

Correspondence to: Louis Staple, 62 Diana Grace Ave., Dartmouth, NS B2W 6A2, Canada; Email: Louis.Staple@dal.ca

References

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