Potential missed opportunities for organ donation: incidence and risk factors for non-referral among critically ill patients.

Introduction: Many potential organ donors are not referred to the transplant coordination, constituting potential missed referrals. Methods: In this retrospective analysis, we explored risk factors for potential missed referral among patients suffering from acute brain injury, who were admitted to a 32-bed mixed intensive care unit (ICU) between 2018 and 2023 and died after hypoxic-ischemic encephalopathy, traumatic brain injury, or subarachnoid hemorrhage (SAH). Patients with absolute contraindications for donation were excluded. Each patient was categorized as "actual donor", "medical refusal", "personal refusal", or "potential missed referral". The primary outcome was the potential missed referral rate. Results: Of 183 potential donors, 101 (55%) were referred and 82 (45%) were not; on ICU admission, patients in the potential missed referral group were older, had higher severity scores, more comorbidities, and were less likely to have a diagnosis of SAH. In a binomial logistic regression analysis, older age and chronic obstructive pulmonary disease were independent predictors of potential missed referral; donation after brain death and SAH were associated with higher referral rates. Conclusions: This audit identifies areas for improvement to expand the donor pool, including greater recognition of the donor potential of critically ill patients with extra-neurological complications, even in the presence of older age and comorbidities.