Missed Organ Donation Opportunities in Patients With Devastating Brain Injury: A Prospective Population-Based Cohort Study
Bibliographic record
Abstract
OBJECTIVES: Determine the incidence and predictors of missed organ donation opportunities. DESIGN: Population-based, prospective cohort study. SETTING: All adult ICU and PICU (medical, surgical, neurologic, and cardiovascular) and emergency departments (EDs) in a Canadian province with a population of 5 million. PATIENTS: Consecutive patients that died with devastating brain injury, regardless of etiology, and were mechanically ventilated in the last 12 hours of life over a period of 42 months. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were defined as eligible potential donors if they were diagnosed with death by neurologic criteria (DNC), probable DNC (neurologic examination consistent, but without full assessment), or had death by circulatory criteria (DCC) within 2 hours of withdrawal of life-sustaining measures (WLSMs). Missed donation opportunities were defined as occurring when there was no evidence in the medical record that the family of an eligible potential donor was approached regarding donation. Multivariable logistic regression was performed to identify predictors of missed opportunities. There were 3481 patients and 1072 eligible potential organ donors, including 481 with confirmed DNC, 154 with probable DNC, and 437 with DCC within 2 hours of WLSM. There were 172 (16%) missed organ donation opportunities. In multivariable analysis, risk factors included older age (odds ratio [OR] per decade, 1.1 [1.0-1.3]), death in an ED rather than ICU (OR, 5.4 [3.0-10.0]), death in a regional rather than urban hospital (OR, 2.8 [1.7-4.6]), and DCC rather than DNC (6.7 [4.4-10.1]). Missed opportunities were less common when the most responsible physician was a donation specialist (OR, 0.3 [0.2-0.5]). Missed cases categorized as probable DNC were proportionally more common in EDs (45%) than in ICUs (21%; p = 0.0005). CONCLUSIONS: Missed organ donation opportunities occur with regularity, especially in EDs and regional hospitals, and among older patients and potential DCC donors. Donation physicians are likely to have a positive impact in reducing missed opportunities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".