Gender disparity in organ donation

Navigating Cultural Challenges in Transplant Surgery: Insights from Turkish Surgeons

To achieve expertise, transplant surgeons in Turkiye undergo rigorous training, including medical school, residency, compulsory service, and extensive training in transplant surgery. Despite their high academic and clinical knowledge level, success in transplant surgery heavily depends on cultural competency. Through semi-structured interviews with 21 transplant surgeons specializing in kidney and liver transplants in Ankara, this study reveals how health illiteracy, culture, and folklore create significant barriers. Surgeons navigate these challenges while enduring harsh working conditions. This research highlights the critical role of cultural competency in transplant surgery, emphasizing the necessity for surgeons to understand and address the diverse cultural needs of their patients. Key findings indicate that surgeons must balance medical expertise with cultural sensitivity to deliver effective care. This study identifies four main cultural barriers: spiritual trust, family politics, health illiteracy, and subcultural incompetency. Effective transplant surgery requires a combination of theoretical proficiency and cultural awareness to meet a patient's needs and improve surgical outcomes.

Semidirected living donors in Israel: Sociodemographic profile, religiosity, and social tolerance

Living kidney donations in Israel come from 2 sources: family members and individuals who volunteer to donate their kidney to patients with whom they do not have personal acquaintance. We refer to the first group as directed living donors (DLDs) and the second as semidirected living donors (SDLDs). The incidence of SDLD in Israel is ∼60%, the highest in the world. We introduce results of a survey among 749 living donors (349 SDLDs and 400 DLDs). Our data illustrate the sociodemographic profile of the 2 groups and their answers to a series of questions regarding spirituality and social tolerance. We find SDLDs to be sectorial: they are mainly married middle-class religious men who reside in small communities. However, we found no significant difference between SDLDs and DLDs in their social tolerance. Both groups ranked high and expressed tolerance toward different social groups. Semidirected living donation enables donors to express general preferences as to the sociodemographic features of their respected recipients. This stirs a heated debate on the ethics of semidirected living donation. Our study discloses a comprehensive picture of the profile and attitudes of SDLDs in Israel, which adds valuable data to the ongoing debate on the legitimacy of semidirected living donation.

A Multicenter Study to Determine Knowledge and Perceptions on Stem Cell Donation, Transplantation Among Saudi Medical Students

BACKGROUND

Despite significant contributions to stem cell research in Saudi Arabia, knowledge and awareness of stem cell research is the subject of ongoing studies with controversial findings, specifically among medical students. This was a cross-sectional study with 685 medical students aimed to explore their knowledge and attitudes in relation to stem cell research and transplantation.

METHODS

A validated survey exploring knowledge and attitudes in relation to stem cell research and transplantation was administered. The total knowledge, attitude, and age scores were presented through mean and SD RESULTS: The results of the present study showed that university students in the Eastern Province had an average 35.88 knowledge of stem cell research. In contrast, the attitudes were positive among the entire study sample, with a mean of 3.79 out of 5. Both men and women had significant knowledge about the definition of stem cells and adult stem cells, bone marrow, whether stem cells can be used for drug testing, and recommended stem cell treatment if available.

CONCLUSIONS

The medical curriculum needs to be refined and enriched with additional data on organ and stem cell donation. This can be further enriched with experimental evidence through additional training initiatives that will allow those with negative attitudes to re-evaluate their perceptions and provide accurate information to patients as future health care providers.

Predictive Value of Camera-based Donor Glomerular Filtration Rate Estimation on the Immediate Renal Allograft Outcome Following Live-related Renal Transplant: A Single-center Retrospective Study

Purpose of the Study

The purpose of this study was to assess the association of measured glomerular filtration rate (mGFR) using camera-based method with early transplant outcomes.

Methodology

Diethylenetriamine pentaacetate renograms of all voluntary kidney donors between January 2016 and December 2022 at Kasturba Hospital, Manipal, India, were retrieved for the study. Recipients' posttransplant biochemical parameters were collected and compared against donors with scaled mGFR >80 ml/min/1.73 m2 (Group 1) and with mGFR between 60 and 80 ml/min/1.73 m2 (Group 2). Donor-recipient pair age, anthropometric parameters, and their differences were also assessed against the immediate transplant outcome. Posttransplant immediate graft function was assessed by posttransplant nadir serum creatinine, day to achieve nadir serum creatinine, the incidence of slow graft or delayed graft function, and serum creatinine at 1-month posttransplantation. Recipients with serum creatinine of >2.5 mg/dl on posttransplant day 7 were taken as slow graft function.

Results

A total of 161 donor-recipient pairs were analyzed in the study. In recipients who showed persistently high serum creatinine posttransplant, older donor age(p < 0.001), higher difference in body mass index among the donor-recipient pair (p= 0.03), and mGFR <80ml/min (p < 0.001) were significantly associated. Slow graft function was significantly more in Group II recipients, with donors having mGFR <80ml/min as compared to Group I with mGFR >80 ml/min (37.3% vs. 10.6%) (P < 0.001).

Conclusions

Camera-based mGFR using Gates' formula is a reliable tool to predict inferior graft outcomes in the immediate posttransplant period. Kidneys from donors with mGFR of 60-80 mL/min/1.73 m2 are likely to experience slow graft function in the immediate posttransplant period.

Access to treatment in chronic kidney disease, dialysis and transplantation. Is there gender equality?

Sex and gender are often used as synonyms. However, while sex describes only a biological state, gender is a dynamic concept that takes into account psychosocial and cultural aspects of human existence that can change according to place and time. Inequality in medicine has been described in several areas. Among them, gender inequality has been disregarded for many years and is now a matter of concern. Chronic kidney disease (CKD) is a growing epidemic worldwide, affecting approximately 10% of the population. Although both men and women are affected, gender equality, especially in access to different treatments, is a matter of concern. We decided to investigate gender equality in patients with CKD. To this end, we conducted a literature narrative review to determine whether gender inequalities were found in CKD patients in general and in access to different treatment modalities in particular. A non-language restricted search was performed until November 30th 2022 in PubMed, SciELO, Trip Database, Google Scholar, MEDES y MEDLINE. We also investigated the situation in this regard in our country. We found that CKD is more prevalent in women than men, nevertheless this prevalence decreases along the CKD stages to the point that more men reach end stage kidney disease (ESKD) and dialysis. Access to transplant (ATT) is higher in men than in women although posttransplant survival shows no gender differences. Finally, most series have shown that women are more frequently Kidney transplantation (KT) living donors than men. Results in our country are similar to the published literature with the exception of a higher proportion of men as KT living donors. As in other areas, gender inequality in Nephrology has been largely overlooked. In this review we have highlighted gender differences in CKD patients. Gender inequality in Nephrology exists and needs to be looked upon in order to reach a personalized clinical approach.

Examining behavioural intention towards organ donation in Hong Kong

Although many people report favourable attitudes towards organ donation, Hong Kong has one of the lowest rates of organ donation globally. The present study examined behavioural intention towards organ donation. A convenience sample of 225 Hong Kong Chinese adults (118 = female) aged 18-82 years were recruited to an online survey. Behavioural intention, attitudes, subjective norms, self-efficacy, knowledge and altruism were examined. ANOVA was conducted to examine key differences based on behavioural intention, regression then examined predictors of behavioural intention to donate before exploratory analysis examined the mediating role of subjective norms on the relationship between self-efficacy and behavioural intention. Findings revealed over one third (38%) of respondents were actively registered as organ donors. Women were significantly more likely to be registered as organ donors. Subjective norms and self-efficacy were strong predictors of behavioural intention to donate, and subjective norms significantly mediated the relationship between self-efficacy and behavioural intention to donate.

An Analysis by the European Committee on Organ Transplantation of the Council of Europe Outlining the International Landscape of Donors and Recipients Sex in Solid Organ Transplantation

Discrepancies in donation and transplantation by sex and gender have previously been reported. However, whether such differences are invariably the inevitable, unintended outcome of a legitimate process has yet to be determined. The European Committee on Organ Transplantation of the Council of Europe (CD-P-TO) is the committee that actively promotes the development of ethical, quality and safety standards in the field of transplantation in Europe. Whilst the ultimate objective is to shed light on the processes underlying potential gender inequities in transplantation, our initial goal was to represent the distribution by sex among organ donors and recipients in the CD-P-TO Member States and observer countries. Our survey confirms previous evidence that, in most countries, men represent the prevalent source of deceased donors (63.3% in 64 countries: 60.7% and 71.9% for donation after brain and circulatory death, respectively). In contrast, women represent the leading source of organs recovered from living kidney and liver donors (61.1% and 51.2% in 55 and 32 countries, respectively). Across countries, most recovered organs are transplanted into men (65% in 57 countries). These observations may be explained, at least in part, by the higher burden of certain diseases in men, childbearing related immune sensitization in women, and donor-recipient size mismatch. Future research should establish whether gender-related socially-constructed roles and socioeconomic status may play a detrimental role reducing the access of women to transplantation.

Sex and Gender Differences in Kidney Transplantation

Sex and gender often are used interchangeably, but are two distinct entities, with sex being the biological attribute and gender including the social, psychological, and cultural aspects of one's identity. Kidney transplantation has been proven to be the best treatment for end-stage kidney disease, improving both quality of life and life-expectancy for most patients. However, gender disparities in access to and outcomes of kidney transplantation remain despite the plethora of evidence showing the advantages of kidney transplantation to our patients. Data have shown that women are less likely to be waitlisted for a kidney transplant and to receive a deceased donor or a living donor kidney. On the other hand, women are more likely than men to become living kidney donors. Although some state the latter is the result of the female gender to nurture and care for loved ones, others believe this observation is because women often are incompatible with their spouse or child because pregnancy is a strong sensitizing event, which stems from the biological rather than the social differences between the sexes. Influence of sex and gender is not limited to access to kidney transplantation, but rather exist in other areas of transplant medicine, such as the difference observed in transplant outcomes between the sexes, variability in immunosuppression metabolism, and even in more contemporary areas such as recent data showing sex-based differences in outcomes of kidney transplant recipients with coronavirus disease-2019, with males having an increased incidence of acute kidney injury and death.

The Gendered Body Work of Muslim Arab Mothers Who Donate a Kidney to Their Children

PURPOSE

Previous studies showed that among the pediatric ESRD patients who receive a kidney donation from a parent, in most cases the mother is the one that agrees to donate her kidney to the sick child, whereas fathers are less willing to donate. The present study sought to explore decision making regarding which parent would donate a kidney to their child among Muslim Arab parents of pediatric ESRD patients.

DESIGN AND METHODS

The study design is a cross sectional qualitative study. We conducted semi-structured interviews with thirty-one parents: twenty-five mothers and six fathers, who donated a kidney to their child.

RESULTS

Parents tended to refrain from donating a kidney to a sick daughter; mothers were more willing to donate than fathers. Our findings imply that culturally constructed notions of gender and motherhood are mobilized to the realm of health and illness, and mothers' body work is an influential factor in determining survival chances of pediatric ESRD patients and their quality of life.

CONCLUSIONS

Our study shows that kidney donation made by mothers to their children represents a gendered body work and powerfully demonstrate gender relations in Arab society. Cultural artefacts shape parents' differential propensity to donate organs for a female or a male offspring.

PRACTICE IMPLICATIONS

It is recommended that the nursing staff enlist the help of Muslim clerics to increase the willingness of fathers to donate a kidney for their offspring, and also to encourage both parents to donate a kidney to a sick daughter. Education campaigns are needed to raise awareness and encourage changes in the attitudes of the Muslim families of pediatric ESRD patients toward parental kidney donation.

Non-alcoholic fatty liver disease and obesity among adult donors are major challenges to living donor liver transplantation: A single-centre experience

OBJECTIVES

Obesity and non-alcoholic fatty liver disease (NAFLD) are rampant in South East Asia. There is paucity of data exploring its' impact on donor suitability for living donor liver transplantation (LDLT). We aimed to describe and examine the factors related to non-utilization of potential donors in our LDLT programme.

METHODS

This is an analysis of prospectively collected data on potential donors for an adult LDLT programme, between January 2017 and December 2019.

RESULTS

Fifty-five donors for 33 potential recipients were evaluated. The mean age was 31.6 ± 8.5 years, 52.7% were female and the ethnic divisions were: Chinese (50.9%), Indian (25.5%) and Malay (23.6%). The mean body mass index (BMI) among potential donors was 25.1 ± 4.0 kg/m²; 25.5% of donors had normal BMI, 23.6% were overweight and 50.9% were obese. Using the CAP modality of Fibroscan®, we identified the following grades of hepatic steatosis: 36.6% S0, 19.5% S1, 2.4% S2 and 41.5% S3. The non-utilization rate of our donors was 74.5% (41/55) and the main reasons were significant hepatic steatosis and/or obesity. Compared to suitable donors, unsuitable donors had significantly greater mean BMI, mean CAP scores, higher rates of dyslipidaemia and NAFLD.

CONCLUSION

NAFLD and obesity represent major challenges to an emerging LDLT programme in Malaysia.

Practice patterns of corneal transplantation in Europe: first report by the European Cornea and Cell Transplantation Registry

PURPOSE

To report practice patterns of corneal transplantation in Europe.

SETTING

Corneal clinics in 10 European member states (MS), the United Kingdom, and Switzerland.

DESIGN

Multinational registry study.

METHODS

Corneal transplant procedures registered in the European Cornea and Cell Transplantation Registry were identified. Preoperative donor and recipient characteristics, indication and reason for transplantation, and surgical techniques were analyzed.

RESULTS

A total of 12 913 corneal transplants were identified from 10 European Union MS, the United Kingdom, and Switzerland. Most countries were self-sufficient with regard to donor tissue. Fuchs endothelial corneal dystrophy was the most common indication (41%, n = 5325), followed by regraft (16%, n = 2108), pseudophakic bullous keratopathy (12%, n = 1594), and keratoconus (12%, n = 1506). Descemet stripping automated endothelial keratoplasty (DSAEK, 46%, n = 5918) was the most commonly performed technique, followed by penetrating keratoplasty (30%, n = 3886) and Descemet membrane endothelial keratoplasty (9%, n = 1838). Vision improvement was the main reason for corneal transplantation (90%, n = 11 591). Surgical technique and reason for transplantation differed between indications.

CONCLUSIONS

This report provides the most comprehensive overview of corneal transplantation practice patterns in Europe to date. Fuchs endothelial dystrophy is the most common indication, vision improvement the leading reason, and DSAEK the predominant technique for corneal transplantation.

An intersectional gender analysis in kidney transplantation: women who donate a kidney

BACKGROUND

Living-donor transplantation is the best treatment option in patients with chronic kidney failure. Global data show that women are less likely to be kidney recipients than men but are more likely to become living kidney donors. We explored the experience of women who donate a kidney to relatives with biological and socio-cultural ties and to understand the similarities and differences in their experience.

METHODS

A qualitative hermeneutic phenomenological study with an intersectional analysis of gender. Ten women donors accepted in the transplant evaluation period participated, all of whom donated a kidney to a pre-dialysis relative. Two categories were included: women with biological kinship ties (mothers, sisters) and women who have a socio-cultural relationship (wives) with kidney recipient. The data were collected through semi-structured in-depth interviews and analysed using thematic analysis.

RESULTS

Women donate their kidneys in a convinced manner, without worrying about their health, with an optimistic and positive attitude, and without believing that they are acting heroically. Women with biological kinship ties see it as a 'naturalization thing'. In contrast, wives donate conditioned by gender roles, but also as a form of empowerment and as a personal benefit: they donate in order to avoid taking on carer role for their husband and as a way of protecting their children.

CONCLUSION

The study's findings expand the conception of kidney donation as solely altruistic and may help professionals to pay attention to the complexity and intersectionality of features present in women who are living kidney donors.

Equally Interchangeable? How Sex and Gender Affect Transplantation

Organ transplantation as an option to overcome end-stage diseases is common in countries with advanced healthcare systems and is increasingly provided in emerging and developing countries. A review of the literature points to sex- and gender-based inequity in the field with differences reported at each step of the transplant process, including access to a transplantation waiting list, access to transplantation once waitlisted, as well as outcome after transplantation. In this review, we summarize the data regarding sex- and gender-based disparity in adult and pediatric kidney, liver, lung, heart, and hematopoietic stem cell transplantation and argue that there are not only biological but also psychological and socioeconomic issues that contribute to disparity in the outcome, as well as an inequitable access to transplantation for women and girls. Because the demand for organs has always exceeded the supply, the transplant community has long recognized the need to ensure equity and efficiency of the organ allocation system. In the spirit of equity and equality, the authors call for recognition of these inequities and the development of policies that have the potential to ensure that girls and women have equitable access to transplantation.

Perioperative Considerations Regarding Sex in Solid Organ Transplantation

Sex plays a role in all stages of the organ transplant process, including listing, sex/size matching of organs, complications, graft survival, and mortality. Sex-related differences in organ transplantation are likely multifactorial related to biological and social characteristics. More information is needed to determine how sex-related differences can lead to improved outcomes for future donors and recipients of solid organs. This article provides an overview on the impact of sex on various types of solid organ transplant, including kidney, pancreas, liver, lung, and heart transplants.

Chylous Ascites: Complication of Laparoscopic Donor Nephrectomy. Case Report and Review of Literature

BACKGROUND

Chylous ascites (CA) is an extremely rare complication after laparoscopic donor nephrectomy (LDN). It can increase the hospital stay, morbidity in postoperative period and thus negating the benefits of laparoscopic surgery. Most of the cases were managed conservatively, but surgical intervention may be occasionally required. This report describes the importance of accurate localization of the leaking chyle duct and its repair by endosuturing in a renal donor not responding to conservative treatment.

METHODS

A comprehensive review of literature regarding this rare complication after LDN was performed with Pubmed/Medline and Google Scholar using "chyle," "complications," and "laparoscopic donor nephrectomy" as keywords. The demographic profile and management of patients is discussed in detail. The various surgical modalities used to manage these patients are described.

RESULTS

Fifty-four cases of chyle leak/ascites have been reported after LDN in literature to date. Around 77% donors with CA could be successfully managed conservatively with dietary measures and total parenteral nutrition. Surgical intervention was required in nearly 23% donors ranging from clip application, use of argon coagulation, endosuturing with application of glue after 36.1 ± 19.07 days of failed conservative treatment. Donors with massive ascites or requiring frequent large-volume paracentesis on conservative treatment are likely to require surgical therapy. The present case was successfully managed with laparoscopic endosuturing and has no recurrence at 6 month follow-up.

CONCLUSIONS

Chylous ascites is a rare complication after donor nephrectomy in experienced centers. Although conservative management remains the first line of treatment, early surgical treatment shall be undertaken in cases of massive ascites.

Gender dynamics in the donation field: human tissue donation for research, therapy and feeding

This paper examines how gender dynamics shape human tissue donation for research and for human health. Drawing on research investigating the donation of different types of bodily tissues including blood, plasma, breastmilk, cord blood, foetal tissue and placentae we consider how and why women and men are viewed as different kinds of donors. We situate these donation practices within a broader understanding of gender difference to explain why any sociology of donation needs to take account of gender. In so doing we explore how tissue derived from the bodies of women acquires value in distinctive ways and for distinctive purposes and reasons. Within these gendered bioeconomies of donation, the supply and demand for tissue is structured by social understandings of maternity, parental responsibility, and risk, which in turn affect the experiences of donors.

Gender Imbalance and the Relationship Between Living Donors and Recipients in Liver Transplantations in an Organ Transplant Center in Turkey

OBJECTIVES

Because of the scarcity of publications on gender differences and the relationship between living donors and recipients in liver transplant procedures, we carried out this study with the objective to examine the gender distribution of donors and recipients and the relationships between donors and recipients in living related-donor liver transplants performed in a university hospital in Ankara, Turkey.

MATERIALS AND METHODS

We retrospectively evaluated the data of 549 patients who underwent living related-donor and deceased-donor liver transplant procedures conducted in a university hospital between 1988 and 2017 and the 409 living donors.

RESULTS

Males constituted 53.1% of the 409 living related liver donors and 63.6% of the living liver recipients. We found that 72.9% of the deceased-donor liver transplant recipients were also male. Of living related donors, 91.4% were blood relatives, with 74.8% being first-degree relatives. The most common donor-recipient relation was mother to son. Analyses of interspousal donations showed a significant difference between husband to wife and vice versa (7 vs 17; P < .05).

CONCLUSIONS

Most recipients and donors in living related-donor liver transplants were males with a young predominance. It is not known whether this might be related to biologic, psychologic, or socio cultural features of patients, gender issues, or economic factors. Further research with qualitative components on the influential factors, including gender, is needed.

Donor Cornea Harvest Techniques: Comparison Between Globe Enucleation and In Situ Corneoscleral Disc Excision

PURPOSE

To compare whole eye enucleation and corneoscleral disc (CD) excision as donor cornea harvesting techniques for possible effects on corneal cultivation and the clinical outcome of the corneal grafts after transplantation in 2929 cases.

METHODS

A retrospective analysis was performed on the Hamburg Eye Bank database using comparative statistics. The standard method for donor cornea recovery at the Hamburg Eye Bank changed from enucleation of the whole eye to CD in situ excision in 2008. Corneas recovered between 2003 and 2013 were included in this study. We compared the contamination rate, the endothelial density after retrieval, endothelial cell loss during cultivation, and the clinical outcome (visual acuity, astigmatism, and refraction) of transplanted corneas.

RESULTS

Once the retrieval method was changed from whole globe enucleation to in situ CD excision, the donation numbers increased (after several years of constant decrease). Furthermore, we observed slightly lower endothelial cell density after retrieval in corneas obtained by in situ CD excision compared with those from enucleated eyes, whereas endothelial cell loss during cultivation was similar. After changing the recovery procedure to in situ excision, initially a higher rate of contamination was observed, but but it eventually decreased. Finally, the corneas of both groups had a similar clinical outcome.

CONCLUSIONS

After a transient technical learning period, in situ CD excision proved to be a method of donor cornea recovery with similar cultivation performance and clinical results compared with whole eye enucleation. It also may have led to higher willingness to donate, possibly because of better acceptance by the relatives of the deceased.

Organ transplantation and gender differences: a paradigmatic example of intertwining between biological and sociocultural determinants

Organ transplantation, e.g., of the heart, liver, or kidney, is nowadays a routine strategy to counteract several lethal human pathologies. From literature data and from data obtained in Italy, a striking scenario appears well evident: women are more often donors than recipients. On the other hand, recipients of organs are mainly males, probably reflecting a gender bias in the incidence of transplant-related pathologies. The impact of sex mismatch on transplant outcome remains debated, even though donor-recipient sex mismatch, due to biological matters, appears undesirable in female recipients. In our opinion, the analysis of how sex and gender can interact and affect grafting success could represent a mandatory task for the management of organ transplantation.

A peer outreach initiative to increase the registration of minorities as organ donors

Background

Black, Asian and minority ethnic (BAME) communities are disproportionately affected by inequalities in transplant services in the UK. There are some indications from pilot programmes that appeals for BAME organ donors may be more effectively communicated by employing grassroots, community-networking approaches, but such initiatives have not been adequately described or evaluated.

Methods

Lay individuals from BAME communities were trained as peer outreach workers. They attended a series of public events to promote knowledge of organ donation and transplantation among the public. Information was gathered from 806 evaluation forms completed by event attendees at 34 separate events. From these, 54 follow-up interviews were conducted with event attendees who completed evaluation forms, indicated that they intended to sign up to the NHS Organ Donor Register (ODR) within the next month and consented to follow-up.

Results

Peer outreach initiatives of the type evaluated are associated with increased numbers of BAME people registering as organ donors. A total of 8.8% of event attendees signed up to the NHS ODR. The programme was most effective with people who had previously considered becoming organ donors but who did not know how to go about it. It was less effective with people who had not previously considered it, or who were scared about signing up, or who feared family or religious disapproval.

Conclusions

Peer outreach programmes with BAME communities can be an effective way of reducing inequalities by increasing the number of people on the NHS ODR and encouraging people to think about the issue.

The importance of emergency medicine in organ donation: successful donation is more likely when potential donors are referred from the emergency department

OBJECTIVES

This study sought to identify factors that are associated with successful organ retrieval among patients referred to organ procurement services for potential organ donation. Particular attention was paid to the frequency, patient characteristics, and outcomes of patients referred for donation from the emergency department (ED).

METHODS

For this retrospective cohort study, data were collected on all solid-organ donor referrals made to a single organ procurement organization serving 78 hospitals over a 45-month period. Data retrieved included patient age, sex, race, referral site (ED vs. inpatient), and mechanism of injury. Outcome of referral (organs retrieved or not) was the primary outcome variable. Pearson chi-square and Student's t-tests were used for bivariate statistical analysis. Multiple logistic regression analysis was used to determine which variables remained associated with organ retrieval after controlling for potential confounders.

RESULTS

A total of 6,886 donor referrals were made in the study population. Of these, 155 were excluded due to incomplete data, leaving 6,731 subjects for analysis. Using bivariate statistical analysis, we found that successful organ retrieval was associated with younger age (donor mean age 40.8 years, 95% confidence interval [CI] = 39.1 to 42.5 vs. nondonor mean age 59.4, 95% CI = 58.9 to 59.9), mechanism of injury (p < 0.001), and referral from the ED (ED 15.5% retrieved, inpatient 5.9%, odds ratio [OR] = 2.92, 95% CI = 2.32 to 3.67). After controlling for potential confounders with multiple logistic regression, referral from the ED remained significantly associated with successful organ retrieval (OR = 1.52, 95% CI = 1.18 to 1.97), as did age (OR = 0.96, 95% CI = 0.96 to 0.97) and mechanism of injury (p < 0.001). On regression analysis, race emerged as a significant predictor of organ retrieval (p < 0.001). Medically suitable patients referred from the ED were significantly more likely on bivariate analysis to have consent for donation granted compared to patients referred from inpatient settings (OR = 1.48, 95% CI = 1.03 to 2.12), but this association was not found to be significant on regression analysis (OR = 1.37, 95% CI = 0.93 to 2.02).

CONCLUSIONS

Referral of potential organ donors from the ED is associated with an increased likelihood of successful organ retrieval. The authors conclude that further attention and resources should be directed toward the role of emergency medicine (EM) in the organ procurement process, owing to the relatively high likelihood of successful organ retrieval among patients referred from the ED.