A retrospective analysis of patients eligible for organ donation in adult intensive care units in Aotearoa New Zealand.

Abstract

To analyse characteristics of patients eligible for organ donation in New Zealand (NZ) Intensive Care Units (ICUs) and identify potentially modifiable factors that may benefit donation conversations and their outcomes. Design: A retrospective analysis of eligible patient data collected by Organ Donation New Zealand (ODNZ). Twenty-three adult ICUs in NZ from January 1, 2018, to December 31, 2021. Participants: Adult ICU patients eligible for organ donation via neurological determination of death (DNDD) or circulatory determination of death (DCDD). Patient and ICU characteristics, preparations for donation conversations, donation decisions, and reasons for non-approaches or declines were analysed. Descriptive statistics and binary logistic regression evaluated factors and outcomes. A total of 1,267 cases were analysed (DNDD = 687, DCDD = 580). Donation conversations occurred in 46.9% of cases, with 51.3% resulting in consent. Patients' demographics and admission trends were similar to international reports. Male gender (p = 0.016) and ICU length of stay (p = 0.003) were associated with increased DCDD consent likelihood. Conditions such as encephalopathy (p = 0.012), and cardiovascular disease (p < 0.001) were associated with reduced donation conversation likelihood. Families of Māori patients were associated with reduced donation conversation likelihood (p = 0.002) and families of Māori (p < 0.001), Pasifika (p < 0.001), and Asian patients (p = 0.004) were associated with reduced consent likelihood. Early consultation with ODNZ and timely brain death confirmation positively impacted donation conversations and consent rates. Although not always practised, early ODNZ consultation and timely brain death confirmation were modifiable factors positively associated with conversations being approached and consent. Research exploring ICU staff and families' perspectives may improve understanding of influencing factors.