Benchmarking in the process of organ donation after brain death: proposal of a methodology to identify actual potential donation [Tesi di dottorato]
Pisa University, 2013-03-08

Introduction: The loss of a potential donor can be regarded as an adverse event, since it causes the impossibility to a transplant, with the relative personal and social consequences. A critical aspect in the analysis of efficiency of the process of organ donation is that this is oriented to the measurement of individual phases, starting with the reporting of potential donors, whereas the activities that precede the activation of the donation process, which mainly consist in the management of the cerebral lesion, may be neglected. This issue is of importance, as proven by the observation, that over 50% of deaths with acute cerebral lesion in the ICU are encephalic deaths. However, inconsistency and heterogeneity on how data on cerebral lesion and death are collected in different settings remain a major problem. The objective of this thesis is to propose a method which allows a more uniform data collection regarding deaths with acute cerebral lesion in the ICU. This could improve the quality of the data and provide indicators to better identify more realistic potential donor scenarios. Materials and Methods: We performed a retrospective observational analysis of deaths with acute cerebral lesion in the ICUs of Tuscany region from 01/01/2009 to 31/12/2011; data of the Regional Quality Programme versus those in the Hospital Discharge Forms were compared. The analysis was carried out in following steps: a. identification of the parameters of extraction in the Hospital Discharge Forms in order to avoid the introduction of confounding factors into the processing, such as, for example, the diagnosis of chronic brain injury; b. identification of a common parameter in the cases of encephalic death; c. application of the parameters identified to estimate the phenomenon of death with cerebral lesion, with the possibility of progression to brain death, out of the ICU. Results: a. Principal and first secondary diagnosis are the parameters for the extraction of deaths with cerebral lesion from Hospital Discharge Forms that are consistent with the diagnosis of the Regional Quality Programme b. there is a very significant difference (p <0.001) between the brain deaths identified in patients who have had a hospital stay <= 72 hours and those with a stay of > 72 hours, this showing that the length of hospitalization affects the progression to brain death c. the extraction of data [according to a) and b)] from Hospital Discharge Cards related to deaths outside the ICUs showed that out of 1,690 deaths, 71.71% (1212) were in the age group over 80 years, 25.32% (428) between 60 and 80 and only 2.95% (50) were under the age of 60 years. The method described in this thesis could be used on a large scale to extract and analyze data of patients dead with cerebral lesion in the ICU. Its use would allow the comparison of the real potential and efficiency of the system to detect and report deaths with cerebral lesion in the individual regions. The implementation of the research outside the ICUs may add quality to the determination of what are the real donation potential at local and national levels, to support the clinical governance.

diritti: info:eu-repo/semantics/openAccess
Marchetti, Piero

Tesi di dottorato. | Lingua: it. | Paese: | BID: TD20016491