120.4: Preventable harm in the Canadian organ donation and transplantation system (semi colon) a descriptive study of missed organ donor identification and referral
Notice bibliographique
Résumé
Introduction: Deceased organ donation is predicated on timely identification and referral (IDR) of potential organ donors, as failure to perform this first, critical step jeopardizes the downstream donation process (Figure). Many Canadian provinces have legislated mandatory referral of potential deceased donors; yet, untimely or missed IDR are examples of missed donation opportunities (MDO) which are safety events where best or expected practice has not occurred. MDOs cause preventable harm to patients and families denied the opportunity of donation at end of life (EOL), and transplant waitlist patients denied access to lifesaving organs. Currently the Canadian organ donation and transplantation (ODT) system is unable to quantify this preventable harm, nor plan and monitor improvement initiatives to reduce it. Our objective was to determine the national rate of donor IDR, estimate the number of MDO from missed IDR, and quantify the consequential preventable harm to Canadians patients and their families at the EOL and on the transplant waitlist. FigureMethod: We requested donor definitions and data to calculate IDR, consent, and approach rates from all 11 Canadian organ donation organizations (ODO) for 2016–2018. We then estimated the number of missed IDR patients who were eligible for approach (safety events) and the associated preventable harm to patients at EOL and on transplant waitlists. Results: Annually, there were 63–76 missed IDR patients eligible for approach (3.6–4.5 per million population [PMP]) from four ODO — three with mandatory referral legislation. Applying each ODO’s approach and consent rates for the corresponding year, there were 37–41 missed donors (2.4 donor PMP) annually. Assuming three transplants per donor, the theoretical number of missed transplants would be 111–123 (6.4–7.3 transplants PMP) annually. Data from the four Canadian ODO demonstrates that missed IDR safety events resulted in important preventable harm measured by a lost opportunity for donation of 2.4 donors PMP annually and 354 potentially missed transplants between 2016–2018. Conclusion: Missed identification and referral of potential organ donors causes harm by denying both the opportunity to donate at end of life and access to lifesaving or life-enhancing organs to vulnerable patients awaiting transplant. This safety event and its consequential preventable harm is unmeasured and unrecognized, so there is no accountability or disclosure of these patient safety events. Future work is needed to standardize the definition of a potential donor, clinical referral triggers, and the reporting of missed donor identification and referral to allow for accurate measurement and reporting of these patient safety events and to facilitate accountability mechanisms.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,003 | 0,006 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».