Donation from emergency department
Almost all deceased donors in the UK die from a devastating brain injury and the majority will die in an intensive care unit (ICU). Many of these patients are admitted to hospital via an Emergency Department (ED) and in some cases clinicians will determine such injuries to be non-survivable at this early stage whilst the patient is in the ED. It follows that ED staff should be as familiar with how to recognise when donation is a possibility as their colleagues in the ICU, have robust systems in place to ensure prompt referral to organ donation services and receive appropriate support from the rest of the hospital when the possibility of donation is pursued further. There is evidence that this is not always the case and that some dying patients are being denied the option of donation as a result.
The Emergency Department strategy launched in November 2016 and has two high level objectives, one aligned to what might be considered current practice and the other to possible developments in the immediate care and assessment of patients with devastating brain injury. Both are based upon a ‘whole hospital’ approach to organ donation in which the role of the Emergency Department is presented within a framework focused on the needs of a dying patient.
In summary the ask of all hospitals is that
- Every Organ Donation Committee should have a fully engaged ED representative.
- Every Organ Donation Committee should be satisfied that before organ donation becomes part of end of life care in the ED, it is being robustly established that further life sustaining treatment is not of overall benefit to the patient.
- Every hospital should have a hospital organ donation policy that promotes best practice, regardless of the location of the dying patient, by the end of 2017.
- CLODs and SNODs should deliver the PowerPoint slide set accompanying the Strategy to key ED staff at least once in 2017 and create a local mechanism for the regular training and updating of ED staff.
More information about each of these hospital level actions can be found in the Emergency Department Strategy document.