An online survey regarding the possibility of an organ/tissue donation in non-ventilated dying stroke patients was sent via a web-based survey portal to members of the British Association of Stroke Physicians. All responses were obtained online and results were compiled using Trust approved software.

While the demand for tissue and organ donation in the UK has increased, the number of donors has not changed over the past few years. A huge number of people worldwide are estimated to be awaiting organ or tissue donation without which their life is in danger.8 One of the major causes of reduced availability of organs and tissues is lack of awareness and failure to identify potential donors. 

Awareness about organ and tissue donation is significantly lacking among stroke physicians in the UK. In order to increase the number of organ and tissue donors, it is necessary to introduce measures and pathways to improve awareness among the treating medical teams and streamline the organ and tissue donation process. 

Deaths in the stroke unit are usually expected and can involve any age group. The stroke physician has a duty to the dying persons to keep them comfortable and pain free. The duty of care is also owed to relatives and family members of dying persons to meet their expectations. In addition, as stroke physicians we should use all available resourses in the most efficient way and any patient who is on an end of life care pathway in an acute stroke unit should be considered as a potential tissue or organ donation candidate.

Thousands of lives can be transformed by early recognition of potential donors in acute stroke units. Thus a life lost can be a source of hope for others who are waiting for transplantation. Due to the increased demand for organs and tissues for transplantation, all stroke team members working in acute stroke units should be aware of national transplant guidelines and there should be agreed pathways in place so that timely intervention can be instigated with minimal disturbance to bereaved families and relatives. 

Improved awareness and better understanding of organ donation principles should enable an increased number of organs and tissue donation from dying stroke patients. We will present our protocol which should be transferable and of benefit to all stroke units and which could be integrated into local hospital end of life care pathways. 


Objectives
Our main objective was to study the level of awareness among stroke physicians about organ and tissue donation and based upon these results to devise a common pathway to streamline the donation process from known
non-ventilated dying stroke patients.

Method
An online survey with a simple tick box (yes or no) response was sent via a web-based survey portal. This survey was sent to 70 members of the British Association of Stroke Physicians (consultants, speciality doctors and specialist registrars). Questions included whether a patient dying of stroke may be a candidate for organ or tissue donation. If the answer was yes, further questions included what organs or tissues could be considered, whether there are any age restriction for the patients, and duration after death specific for various organs and tissues (such as cornea, skin, tendon, bone and heart valves)? Finally physicians were asked about malignancy exclusion for tissue or organ donation.

 Results
Seventy responses were received of which fifty one (72.9%) were complete. Among the responders, 57 (81.4%) were consultants, four (5.7%) were specialty doctors, eight (11.4%) were specialist trainees and one (1.4%) was an affiliate member. 54.8% responses mentioned that patients dying of stroke are eligible for organ donation and the rest (45.2%) of the responses answered wrongly or opted for ‘did not know’. On questions regarding guidelines for age restriction, 30.3% physicians answered correctly for cornea, 5.6% for bone, 2% for skin, 4% for tendon and 10% for heart valves donation. 6.1% knew that organs should be retrieved with 24 hours. 11.8% responders replied that some malignancies will exclude organ donation and the rest either answered wrong or opted for don’t know answers.

Discussion
Deaths in the acute stroke unit are frequently expected and can involve any age group. Stroke physicians should provide best medical care to patients who are on end of life care pathways. It is of paramount importance that religious and psychological needs of relatives and family members of dying patients are addressed. As physicians we should use all available resources for the benefit of society as efficiently as possible. Solid organs like kidneys and liver need perfusion so they are normally supplied from ventilated patients in intensive care settings. But other tissues like cornea, tendon, bones, and skin and heart valves are quite resistant to ischaemia and can be retrieved up to 24 hours after death, provided they are frozen in the first four hours.1,2

With the advent of thrombolysis and acute stroke unit care, more patients are surviving their acute stroke, but mortality after acute stroke remains around 12%. Acute stroke units across the country can be a big potential source for organ and tissue donation that will have a revolutionary change in the life of patients waiting for transplantation.

The above study was conducted to determine the level of awareness among stroke physicians about organ and tissue donation. Patients going on end of life care pathways should be considered as potential organ and tissue donors. A different study has shown that there is a significant correlation between healthcare staff awareness about donation procedure and organ and tissue retrieved.3 Healthcare staff in intensive care settings are generally more aware of the transplantation procedure than the rest of hospital.4

The physicians and the nursing staff in acute stroke units may not refer potential donors due to lack of familiarity with tissue donation and transplantation procedure, difficulty identifying a potential donor or simply limited time availability due to other clinical commitments.5,6 There have been recent studies that have shown education about transplant procedure and establishment of local or nationally agreed protocols for tissue and organ donation alter the attitude of healthcare staff towards donation.7 Therefore, there is a very strong need to develop a close coordination between transplant professionals and acute stroke unit staff members to develop an educational programme to increase their knowledge base about organ and tissue transplantation. Donation approval rates increased if the transplantation request is by trained healthcare staff.8

The findings of our study can be utilised to develop a common pathway that can be used in all UK acute stroke units and could streamline organ and tissue donation process by early identification, discussion with family and timely involvement of the transplant team once all contraindications are excluded.

Conclusion

With the advent of thrombolysis, acute stroke units, reorganisation of better care and rehabilitation, more patients are being discharged from stroke units. Patient independence has increased from 31% to 62% and mortality has reduced from 23% to 12% in the last few years at Southend University Hospital. Unfortunately, patients still die after stroke, but there is considerable scope for tissue and organ donation from patients such as these. Better knowledge about suitability of organ and tissue donation among stroke physicians will help to streamline organ donation in future. We present our protocol, which should be transferable and of benefit to all stroke units and which could be integrated into local hospital end of life care pathways. 

Conflict of interest: none declared
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