Number of deaths by neurological criteria, and organ and tissue donation rates at three critical care centres in Canada.
OBJECTIVE
Comparative organ donation rates are expressed per million population and by this measurement, Canada lags behind other countries. These estimates do not account for differing demographics and health patterns of populations which can result in different rates of death by neurological criteria and subsequent donation rates. We sought to measure directly the number of deaths by neurological criteria, the associated donation rates, and the reasons for the differences.


METHODS
A prospective evaluation of deaths by neurological and cardiorespiratory criteria in the critical care areas of three major adult Canadian tertiary care centres over a seven month period was undertaken. Patients were assessed for eligibility for organ and tissue donation and ultimate disposition.


RESULTS
Annualized rates of death by neurological criteria varied from 2.3%-7.5% (8.6-28 patients) of all deaths. Conversion to actual donors ranged from 20-86%, with family refusal rates accounting for most of this variation. There were only three cases of suspected death by neurological criteria where a complete examination was not performed.


CONCLUSIONS
There is substantial geographic variability in the rate of neurological death and actual organ donation rates in these Canadian tertiary care centres. These variations are principally related to regional differences in demographics of brain injury, referral patterns and donation consent rates, rather than lack of identification of potential donors.
Baker
Andrew
A
Department of Critical Care, St. Michael's Hospital, Toronto, Ontario, Canada. bakera@smh.toronto.on.ca
Beed
Stephen
S
Fenwick
John
J
Kjerulf
Maria
M
Bell
Hilda
H
Logier
Suzie
S
Shepherd
John
J
D000328:Adult; D001926:Brain Death / Q000175:diagnosis*; D002170:Canada; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D009460:Neurologic Examination; D011446:Prospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*