Despite a growing need for transplantable organs, health care professionals are uncomfortable approaching families for organ donation. 25 While actually harvesting organs in the ED would be a rare event, many organs can be harvested up to 24 h after death if the body is refrigerated within 4 h of death. These harvestable organs include such tissues as cornea, bone, skin, tendon, fascia, cartilage, saphenous vein, and heart valves. 26 Contraindications to donation include age greater than 80, death from infectious disease, cancer (although corneas may still be donated), or toxic exposure. 26 2.Z Patients with fatal exposures to cocaine, ethanol, carbon monoxide, lead, and barbiturates have donated successfully. Consultation with a toxicologist is recommended in these circumstances. 28
There are several barriers to tissue procurement in the ED. One study showed that only 43 percent of families were approached, with a successful donation rate of 12 percent. Reasons given for not approaching families included coroner's case (35 percent), family not available (20 percent), family too upset (18 percent), deceased medically unsuitable (14 percent), and no patient identification (12 percent). Time constraints are an additional barrier to successfully obtaining donation. Limited time to both develop rapport with families and to allow them to come to terms with the death, along with a busy staff, have been cited as reasons for unsuccessful donation efforts.26
The appropriate time to make a request for organ donation is after the family has viewed the body. At this point an interval has occurred from the actual notification and the bereaved have had time to come to accept the death as real. A premature request for organ donation may leave the family with doubts about the resuscitative efforts. The family is informed that they are not charged for any procedures related to the donation and that no alteration in appearance of the deceased occurs. 19
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