Analysis of potential donor losses in the emergency departments of non-transplanting hospitals in the Community of Madrid (Spain)

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OBJECTIVE: In 2022, a retrospective analysis was conducted in public hospitals in the Community of Madrid (Spain) without transplant programs. The aim was to evaluate the loss of potential donors with catastrophic brain injury. METHODS: We used clinical and administrative databases (CMBD, CORE-ONT, and HORUS). Deceased patients with compatible diagnoses according to ICD-10 were included, excluding those with active tumor disease. Relevant clinical variables were analyzed, and patients were categorized into 3 groups: evaluated as donors, ineligible as donors, and potential donors not evaluated. Statistical analysis included univariate techniques and a multivariate analysis using categorical principal components analysis (CATPCA). RESULTS: Out of 1,429 deceased patients, 12 evaluated donors, 39 ineligible donors due to medical criteria, and 33 potential donors who were not evaluated were identified. This last group represents a significant loss in donation potential. Most effective donors were patients younger than 70 years admitted to hospitals with neurosurgery, in intensive care units, with prolonged mechanical ventilation, and without severe organ failure. In contrast, non-donors presented higher rates of comorbidities such as septic shock or renal failure. Multivariate analysis via CATPCA identified a total of 3 patient patterns and highlighted a significant group of missed potential donors. CONCLUSIONS: These findings reinforce the need to implement strategies to improve early donor detection, such as emergency department staff training, inter-hospital collaboration, and use of technological tools. The study concludes that a structured intervention could significantly reduce donor loss in non-transplant centers.

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