THERE HAS BEEN a reduction in the percentage of deceased patients becoming organ donors, according to the latest National ICU Audit Annual Report.

Brain death was diagnosed in 103 patients in 2021, the year in question, with only 50 becoming organ donors.

The biggest factor in these patients not becoming an organ donor was families not consenting, something that happened in 27 cases.

However, most families (72%) consented to their relative becoming an organ donor – a figure that is high by international standards.

Brain death was diagnosed in 98 patients in 2020, 49 of whom became organ donors. Brain death was diagnosed in 110 patients in 2019, 59 of whom became organ donors.

Ten patients became organ donors after circulatory death in 2021, an increase from six in 2020 and eight in 2019.

The proportion of all deceased patients who progressed to become organ donors has fallen since 2019 from 4.7% (67 patients) to 3.6% in 2020 (55) and 3% (60) in 2021, according to the report.

Some 19 (28%) out of 69 patients whose families consented did not proceed to donation – most commonly because the organs were considered unsuitable by the transplant teams, which happened in the case of 12 patients.

The conversion rate from brain death to organ donation was 48.5% in 2021, a slight reduction from 50% in 2020.

National ICU Audit Annual Report 2021 National ICU Audit Annual Report 2021

Three-quarters (76%) of all brain-death patients were referred to organ donation personnel for consideration regarding organ donation.

The report noted it is “considered good practice to refer all patients diagnosed with brain death to organ donation personnel for consideration as organ donors”.

“There are few absolute contraindications to organ donation from brain-death patients, and even patients who seem unsuitable as donors may be considered in certain circumstances.”

In some cases, failure to refer potential organ donors may have occurred because families had already indicated that they would not assent to donation, the report notes.

The numbers of brain-death patients documented by the ICU audit increased from 98 in 2020 to 103 in 2021 as the number of all deaths covered by the audit increased, but brain deaths as a percentage of all deaths fell from 6.5% to 5.2%.

Nationally, brain death patients made up 5.2% of all deaths in the audit.

Continued investment needed

The annual report, which will be published later today, provides data on 96% of all Intensive Care Unit (ICU) activity in 2021, accounting for 11,420 patients in 26 units across 22 hospitals.

Professor Rory Dwyer, Clinical Lead of the Irish National ICU Audit, said the report “sheds light on the pressure on ICU bed availability, particularly during surges in the Covid pandemic”.

Dwyer noted that 74% of patients admitted to ICU in 2021 “survived to leave hospital alive thanks to allocation of significant resources by the healthcare system to this area”.

“This investment needs to continue in order to meet the challenges of our evolving healthcare landscape,” he said.

The report also found that outcomes were similar whether patients were initially admitted to larger or smaller ICUs.

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Dwyer said the equity in mortality outcomes between smaller and larger ICUs “demonstrates the adaptability of our national ICU network, where patients receive consistent, high-quality care regardless of the size of the unit that patients are initially admitted to”.

Impact of Covid-19

The report notes that Covid-19 patients accounted for 29% of all ICU beds occupied in 2021.

Seventy-three patients admitted to ICU that year due to Covid-19 were pregnant or recently pregnant; all survived and left the hospital alive.

Some 603 patients with Covid-19 died before discharge from an acute hospital, giving a mortality rate of 36%. This is compared to a 24% mortality rate for the overall ICU population, the report states.

On average, 303 ICU or high-dependency unit (HDU) beds were open daily in publicly-funded hospitals in 2021, which corresponds to six critical care beds per 100,000 population, compared to the OECD average of 14.1 per 100,000.

The OECD (Organisation for Economic Co-operation and Development) has 38 member countries globally.

Fifteen hospitals in Ireland met the target of 80% of patients admitted to ICU within four hours of a decision to admit.

The national average bed-occupancy rate was 88.5%, slightly above the recommended level of 85%. Many of the larger hospitals had bed occupancy rates above 90%, the report states.