Analysis of deaths within 24 hours of injury: cost-benefit implications for organ and tissue donations.
OBJECTIVE
To determine useful predictors of successful organ donation in patients who die within 24 hours of injury (early deaths).


METHODS
Retrospective review of a 3-year experience at a Metropolitan Level I Trauma Center.


METHODS
All 223 early deaths among 5,719 trauma patients in a 3-year period were reviewed. This group represented 62% of all trauma deaths.


RESULTS
Forty-six patients (21%) donated 102 vascularized organs and made 66 donations of tissues. Patients with isolated severe head injuries had the highest rate of successful donation (33%). Those with severe head injury and another severe organ injury had a lower rate of donation (13%), and donation was rare (1%) among patients with severe organ injury in the absence of head injury (p < 0.001). There were no organ donors among victims >65 years old or in 64 of 65 patients with a Revised Trauma Score of <2.2. The Revised Trauma Score was significantly higher in organ donors (3.39 vs. 3.07, p < 0.05). The cost-benefit ratio for early deaths was $6,512 per organ/tissue recovered.


CONCLUSIONS
Decisions regarding the resuscitation of trauma patients who have characteristics associated with a recognized low rate of organ donation should be made exclusive of the potential for organ recovery.
Malangoni
M A
MA
Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998, USA.
Mancuso
C
C
Jacobs
D G
DG
Luebke
D
D
Fallon
W F
WF
McHenry
C R
CR
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000191:economics*; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000145:classification* / Q000191:economics / Q000401:mortality