Admission to intensive care for consideration of organ donation in Australia and New Zealand

Andrew P Melville¹, David V Pilcher^1,2,3, Joanna Mitropoulos¹, Steve J Philpot^1,3

¹Intensive Care Unit, Alfred Hospital, Melbourne, Australia, ²Australian & New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Melbourne, Australia, ³Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

Background:

ICU admission for consideration of organ donation remains controversial in some contexts. Limited data is available on the frequency and outcomes of this practice.

Aim:

To define epidemiology of patients admitted to ICU for consideration of organ donation and identify factors associated with outcome.

Methods:

Retrospective analysis of data from the Australian and New Zealand Intensive Care Society Adult Patient Database between 2007 and 2012.

Results:

Between 2007 and 2012, there were 467 admissions to ICU for consideration of organ donation (0.08% of total ICU admissions), and these numbers are increasing, with 118 in 2012. Median length of ICU stay was 25.7 hours (IQR 15.3-41.9). The most common diagnosis was intracerebral haemorrhage. Hospital mortality was 97.2%. 9 patients (1.9%) were discharged home and 4 (0.9%) to a chronic care or rehab facility. No data was available on the proportion that became organ donors. Factors independently associated with survival were increasing age (OR 1.05, 95% CI 1.01–1.10, p=0.012), not being intubated and ventilated (OR 8.1, 95% CI 2.2-29.8, p=0.002) and non-neurological diagnoses (OR 14.2, 95% CI 3.8–53.4, p<0.0001).

Discussion:

Admission to ICU for consideration of organ donation is an uncommon but increasing occurrence and most patients die. Non-neurological diagnoses were associated with survival.

Conclusion:

More work is required to establish the accuracy of these results and extent of possible data error. Survival may represent a failure to identify patients appropriately and assessment of events during ICU stay and functional status of survivors is needed.