Prospective audit of deaths at a teaching hospital.

We undertook a prospective audit of all the deaths in the trauma unit, the emergency unit, and the intensive care units to estimate the number of potential organ donors in the hospital and identify the reasons for nonreferral of potential donors. The transplant coordinators undertook daily visits to the above units and documented all of the deaths occurring in the previous 24 hours. The patient records were reviewed, and the medical and nursing staff interviewed to determine the precise circumstances surrounding the death. Seven of the 14 deaths in the neurosurgical intensive care unit were related to the head injury, and five were certified brain dead and referred as an organ donor. Fifty-eight of 83 deaths in the trauma unit were head injury related; however, only eight were eventually certified brain dead and referred. In the emergency unit, only one of 76 patients who died was certified brain dead and referred as an organ donor. Although many of the deaths in the above units are related to a head injury or cerebral event, very few are actually certified brain dead. All potential donors who were certified brain dead were referred to the transplant team.

Outcome of assessment of potential donors for live donor kidney transplants.

The critical shortage of cadaver donor organs for renal transplantation has resulted in the increased use of living donors. We reviewed the outcomes of the assessments of potential living kidney donors. One hundred seventeen potential donors evaluated over a 39-month period were included in the study. The work-up of the potential donors consisted of a step-wise progression of clinical, blood, and radiological tests. Of the 117 potential donors, only 20 were ultimately used. Five percent of the donors were found to be unsuitable because of medical problems at the initial visit. A further 25% were blood group incompatible, 13% were excluded following the investigations, 9% had psychosocial problems, and in 4% there were recipient problems. Twenty-two percent of suitable donors were not used either because another live donor was used or because a cadaver donor kidney was available. In conclusion, although the assessment of potential donors requires much time and effort, only a small minority of donors assessed are ultimately used.