title: Delayed Referral Results in Missed Opportunities for Organ Donation After Circulatory Death.
abstract: OBJECTIVE
  Rates of organ donation and transplantation have steadily increased in the United States and Canada over the past decade, largely attributable to a notable increase in donation after circulatory death. However, the number of patients awaiting solid organ transplantation continues to remain much higher than the number of organs transplanted each year. The objective of this study was to determine the potential to increase donation rates further by identifying gaps in the well-established donation after circulatory death process in Ontario.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Provincial organ procurement organization.
  
  
  METHODS
  Patients who died in designated donation hospitals within the province of Ontario, Canada between April 1, 2013, and March 31, 2015.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of 1,407 patient deaths following planned withdrawal of life-sustaining therapy, 54.0% (n = 760) were medically suitable for donation after circulatory death. In 438 cases where next of kin was approached, consent rates reached 47.5%. A total of 119 patients became actual organ donors. Only 66.2% (n = 503) of suitable patients were appropriately referred, resulting in 251 missed potential donors whose next of kin could not be approached regarding organ donation because referral occurred after initiation of withdrawal of life-sustaining therapy or not at all.
  
  
  CONCLUSIONS
  The number of medically suitable patients who die within 2 hours of planned withdrawal of life-sustaining therapy is nearly six times higher than the number of actual organ donors, with the greatest loss of potential due to delayed referral until at the time of or after planned withdrawal of life-sustaining therapy. Intensive care teams are not meeting their ethical responsibility to recognize impending death and appropriately refer potential organ donors to the local organ procurement organization. In cases where patients had previously registered their consent decision, they were denied a healthcare right.
authors.affiliation: 1Pediatric Critical Care Medicine, Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, and Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada. 2Trillium Gift of Life Network, Toronto, ON, Canada. 3Nova Scotia Health Authority, Critical Care Organ Donation Program, Halifax, NS, Canada. 4Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 5Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Kristina
authors.initials: K
authors.lastname: Krmpotic
authors.forename: Clare
authors.initials: C
authors.lastname: Payne
authors.forename: Cynthia
authors.initials: C
authors.lastname: Isenor
authors.forename: Sonny
authors.initials: S
authors.lastname: Dhanani
mesh_terms: D000328:Adult; D003422:Critical Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D003643:Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000458:organization & administration / Q000706:statistics & numerical data*