Effect of a multidisciplinary program to improve organ donation in the emergency department

Background and importance: As the emergency department (ED) is an important source of potential organ donors, it may play an important role in the organ donation process.

Objective: To assess the effectiveness of the multidisciplinary organ donation improvement program (ODIP) on identifying potential donors and improving organ donation in South Korean EDs.

Design, settings, and participants: This study was a retrospective, observational study of the ED-inclusive ODIP implemented in 55 tertiary teaching hospitals contracted with the Korea Organ Donation Agency (KODA) since 2014. The inclusion criteria were: patients in the ED with a serious brain injury and futile prognosis or expected death of the patient within a few days, no contraindications for organ donation, and no objections registered in the donor registry.

Intervention: The ED-inclusive multidisciplinary approach was implemented to improve organ donation. It included regular meetings of the ODIP committee, hospital visits and staff education, improvement of notifications, and support of a coordination team.

Outcomes measure and analysis: We assessed the changes in the number of deceased organ donors per year and notifications of potential brain-dead donors by medical staff after the implementation of the new ED-inclusive ODIP. The entire organ donation process was monitored and measured.

Results: There was a significant increase in deceased organ donors per million population after the implementation of the ED-inclusive multidisciplinary ODIP of KODA compared to the pre-intervention period: 5.21 vs. 9.72, difference 4.51 (95% confidence interval 2.11-6.91). During the study period, the proportion of deceased organ donors occurred from KODA-contracted hospitals increased from 25.3 to 50.3% in South Korea's total deceased organ donors. Emergency physicians of KODA-contracted hospitals notified increasingly more potential brain-dead donors each year throughout the study period (36 in 2014 vs. 135 in 2018). The longer the period contracted with KODA, the higher the potential brain-death identification rates (P < 0.001).

Conclusion: In this retrospective study, the implementation of multidisciplinary ODIP in the ED led to significantly higher deceased organ donors per million population and awareness of potential brain-dead donors in South Korea.