Organ and tissue donation from poisoned patients in the emergency department: A Canadian emergency physician survey.

CANADIAN JOURNAL OF EMERGENCY MEDICINE(2019)

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摘要
Objectives Screening for organ and tissue donation is an essential skill for emergency physicians. In 2015, 4,631 Canadians were on a waiting list for a transplant, and 262 died while waiting. Canada's donation rates are less than half of comparable countries, so it is essential to explore strategies to improve the referral of donors. Poisoned patients may be one such underutilized source for donation. This study explores physician practices and perceptions regarding the referral of poisoned patients as donors. Methods In this cross-sectional unidirectional survey, 1,471 physician members of the Canadian Association of Emergency Physicians were invited to participate. Physicians were presented with 20 scenarios and asked whether they would refer the patient as a potential organ or tissue donor. Results were reported descriptively, and associations between demographics and referral patterns were assessed. Results Physicians totalling 208 participated in the organ or tissue donation scenarios (14.1%); 75% of scenarios involving poisoning were referred for organ or tissue donation, compared with 92% in a non-poisoning scenario. Poisons associated with lower referrals included sedatives, acetaminophen, chemical exposure, and organophosphates. A total of 175 physicians completed the demographic survey (11.9%). Characteristics associated with increased referrals included previous referral experience, donation training, donation support, >10 years of service, urban practice, emergency medicine certification, and male gender. Conclusions Scenarios involving poisoning were referred less often when compared with an ideal scenario. Because poisoning is not a contraindication for referral, this represents a potential source of donors. Targeted training and referral support may help improve donation rates in this demographic. CLINICIAN'S CAPSULE What is known about the topic? Patients who die from poisoning are potential organ or tissue donors but may represent an under-referred population. What did this study ask? Do Canadian emergency physicians under-refer patients who die from poisoning for organ or tissue donation, and what characteristics influence referral rates? What did this study find? In a simulated context, poisoned patients were under-referred as potential organ or tissue donors, and both environmental and clinician characteristics influenced rates. Why does this study matter to clinicians? Understanding factors that affect donor referral may decrease the morbidity and mortality for patients waiting for organ or tissue donation.
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关键词
organ donation,tissue donation,poison,toxicology
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