Organ donation after withdrawal of non-invasive positive pressure ventilation: a retrospective observational study
CCCF ePoster library. Boyd J. 11/11/19; 285168; EP42 Disclosure(s)(s): I receive a stipend from the Trillium Gift of Life Foundation for my role as Regional Medical Lead.
Dr. J. Gordon Boyd
Dr. J. Gordon Boyd
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Topic: Retrospective or Prospective Cohort Study or Case Series

Boyd, JG1,2; Singh, JM2,3; Hartwick, M2,4; Soliman, K1,2; Hornby,l2;  Paltser, B2; Wilson, L2; Healey, A2,5

1Department of Critical Care Medicine, Queen's University, Kingston, ON
2Trillium Gift of Life Network, Toronto, ON
3University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON
4Division of Critical Care, Dept. of Medicine, University of Ottawa, Ottawa ON
5Critical Care Medicine, William Osler Health System, Brampton, ON

Despite continual advances in the medical management of organ donors, the need for life saving organs exceeds the supply.  Patients decompensating on non-invasive positive pressure ventilation (NIPPV), who choose withdrawal of life sustaining therapy and palliative care, rather than proceeding to invasive mechanical ventilation, have recently become candidates for organ donation. 
To describe the processes of care, success, and barriers to organ donation after withdrawal of NIPPV.
In this retrospective observational study, the provincial organ donation registry (Trillium Gift of Life Network) was searched for all cases where patients on NIPPV were referred, from January 1st 2017 to November 11, 2018.  Data was abstracted and assessed with descriptive statistics.
During this time period, 457 patients were referred to the provincial organ donation organization in the context of NIPPV withdrawal (Figure 1).  The characteristics of referred patients are summarized in Table 1.  The mean (SD) age was 73 (14), and evenly balanced between males and females.  Only 64 (14%) were eligible for approach, as the remainder were ruled out prior to approach due to medical unsuitability.  Ten substitute decision makers were not approached, due to either their refusal to speak with the organ donor coordinator (n=8), or hospital staff/policy factors (n=2).   Approximately half of approached patients consented to organ donation.  Ultimately, 6 patients went on to donate 10 kidneys, 2 lungs, 3 livers, and 1 collection of pancreatic islet cells.  Documented reasons for lack of recovered organs from consented patients included late diagnosis of medical unsuitability (n=8) and rescinded consent (n=6).   Only 1 patient had their organs refused due to prolonged warm ischemic time following withdrawal of life sustaining therapy.
Patients undergoing withdrawal of NIPPV can go on to be successful organ donors.  Ongoing physician, nursing, family and patient education may increase the number of potential donors from this group of individuals.

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