A prehospital system where obvious futile cases may be terminated prehospitally by physicians may reduce unethical treatment of dying patients. Withholding treatment in futile cases may seem ethically sound but may keep dying patients from becoming organ donors. The objective of this study was to characterise the prehospital patients who underwent organ donation. The aim was to alert prehospital physicians to a potential for an increase in the organ donor pool by considering continued treatment even in some prehospital patients with obvious fatal lesions or illness. This is a retrospective register-based study from the Region of Southern Denmark. The prehospital medical records from patients who underwent organ donation after prehospital care from 1st of January 2016–31st of December 2020 were screened for inclusion. The outcome measures were prehospital diagnosis, vital parameters, and critical interventions. In the five year period, one-hundred-and-fifty-one patients were entered into a donation process in the health region following prehospital care. Sixteen patients were excluded due to limitations in data availability. Of the 135 patients included, 36.3% had a stroke. 36.7% of these patients were intubated prehospitally. 15.6% had subarachnoideal haemorrhage. 66.7% of these were intubated prehospitally. 10.4% suffered from head trauma. 64.3% of these patients were intubated at the scene. In 21.5% of the patients, the prehospitally assigned tentative diagnosis was missing or included a diverse spectrum of medical and surgical emergencies. Twenty-two patients (16.3%) were resuscitated from cardiac arrest. 81.8% were intubated at the scene. The majority of the patients who became organ donors presented prehospitally with intracranial pathology. However, 30% of the patients that later underwent an organ donation process had other prehospital diagnoses. Among these, one patient in six had out-of-hospital cardiac arrest. Termination of treatment in patients with cardiac arrest is not uncommon in physician-manned prehospital emergency medical systems. An organ donation process cannot be initiated prehospitally but can be shut down if treatment is withheld or terminated. We contend that there is a potential for enlarging the donor pool if the decision processes in out-of-hospital cardiac arrest include considerations concerning future procurement of organ donors.

中文翻译：

---

在院外心脏骤停患者中可能会发现器官捐献者的潜力增加

院前系统可能会由医生在院前终止明显无效的病例，这可能会减少对垂死患者的不道德治疗。在徒劳的情况下停止治疗似乎合乎道德，但可能会阻止垂死的患者成为器官捐赠者。本研究的目的是描述接受器官捐赠的院前患者的特征。目的是提醒院前医生通过考虑继续治疗，即使在一些有明显致命病变或疾病的院前患者中也有可能增加器官供体库。这是一项来自丹麦南部地区的基于登记册的回顾性研究。对 2016 年 1 月 1 日至 2020 年 12 月 31 日在院前护理后接受器官捐献的患者的院前医疗记录进行筛选以纳入。结局指标是院前诊断、重要参数和关键干预措施。在五年期间，有 151 名患者在院前护理后进入卫生区的捐赠过程。由于数据可用性的限制，16 名患者被排除在外。在纳入的 135 名患者中，36.3% 患有中风。这些患者中有 36.7% 在院前进行了插管。15.6% 有蛛网膜下腔出血。其中 66.7% 在院前进行了插管。10.4% 的人遭受头部外伤。64.3%的患者在现场插管。在 21.5% 的患者中，院前指定的初步诊断缺失或包括各种内科和外科紧急情况。22 名患者 (16.3%) 从心脏骤停中复苏。81.8%在现场插管。大多数成为器官捐献者的患者在院前出现颅内病变。然而，后来接受器官捐赠过程的患者中有 30% 有其他院前诊断。其中，六分之一的患者出现院外心脏骤停。在由医生操作的院前急救医疗系统中，终止心脏骤停患者的治疗并不少见。器官捐献过程不能在院前启动，但如果治疗被暂停或终止，则可以停止。我们认为，如果院外心脏骤停的决策过程包括有关未来采购器官供体的考虑，则有可能扩大供体库。后来接受器官捐赠过程的患者中有 30% 有其他院前诊断。其中，六分之一的患者出现院外心脏骤停。在由医生操作的院前急救医疗系统中，终止心脏骤停患者的治疗并不少见。器官捐献过程不能在院前启动，但如果治疗被暂停或终止，则可以停止。我们认为，如果院外心脏骤停的决策过程包括有关未来采购器官供体的考虑，则有可能扩大供体库。后来接受器官捐赠过程的患者中有 30% 有其他院前诊断。其中，六分之一的患者出现院外心脏骤停。在由医生操作的院前急救医疗系统中，终止心脏骤停患者的治疗并不少见。器官捐献过程不能在院前启动，但如果治疗被暂停或终止，则可以停止。我们认为，如果院外心脏骤停的决策过程包括有关未来采购器官供体的考虑，则有可能扩大供体库。在由医生操作的院前急救医疗系统中，终止心脏骤停患者的治疗并不少见。器官捐献过程不能在院前启动，但如果治疗被暂停或终止，则可以停止。我们认为，如果院外心脏骤停的决策过程包括有关未来采购器官供体的考虑，则有可能扩大供体库。在由医生操作的院前急救医疗系统中，终止心脏骤停患者的治疗并不少见。器官捐献过程不能在院前启动，但如果治疗被暂停或终止，则可以停止。我们认为，如果院外心脏骤停的决策过程包括有关未来采购器官供体的考虑，则有可能扩大供体库。