Donation Physician Specialists and Missed Organ Donation Opportunities
Notice bibliographique
Résumé
Importance: Donation physicians (DPs) are usually critical care specialists whose responsibilities may include assessment of donation eligibility, care of potential donors, death determination, education, and advocacy. While DP programs have been implemented in some countries with the aim of optimizing the organ donation process, there are few studies evaluating their effectiveness. Objective: To assess the association of a DP program with key performance metrics. Design, Setting, and Participants: This cohort study used interrupted time series analysis to compare baseline data from intensive care units and emergency departments in a Canadian province (December 2019 to February 2020 and March 2021 to May 2021) with data following the initial 3 years of a DP program (July 2021 to June 2024). Donation data included consecutive deceased critically ill patients with various forms of brain injury who received mechanical ventilation in the last 12 hours of life. Exposure: Implementation of a province-wide DP program coupled with regular audit and feedback aimed at identifying and minimizing missed donation opportunities. Main Outcomes and Measures: Missed organ donation opportunities, defined as occurring when families of eligible potential donors were not given the option of donation. Secondary outcomes included appropriate notification of the provincial donation organization, donors per million population, and median number of organs transplanted per donor. Results: Over 42 months, there were 1072 eligible potential donors, including 635 (59%) following death by neurologic criteria and 437 (41%) following death by circulatory criteria. The median (IQR) age was 44.6 (30.8-58.3) years, 662 (62%) were male, and the most common cause of death was hypoxic-ischemic brain injury. During the initial 36 months of the DP program, 129 of 942 (14%) eligible potential donors were missed, compared with 43 of 123 (33%) during 6 months of baseline data (P < .001). The monthly proportion of missed cases decreased by 10.9% (95% CI, -22.0% to 0.3%; P = .06) immediately following the start of the program and then declined -0.7% (95% CI, -0.9% to -0.5%; P < .001) per month. Appropriate notification of the provincial organ donation organization increased 0.9% (95% CI, 0.6% to 1.3%, P < .001) per month. The annual donation rate increased from 14.0 to 23.7 donors per million. The median (IQR) number of organs transplanted per donor did not change (4 [3-5]; P = .69). Missed opportunities occurred in 3% of eligible potential donors when the most responsible physician was a DP and 17% when it was not (P < .001). Conclusions: In this cohort study of consecutive eligible potential organ donors, implementation of a novel DP program was associated with a sustained reduction in missed organ donation opportunities, increased referrals, and a higher deceased donation rate.
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 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 tête enseignante, 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 ».