{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T06:08:13Z","timestamp":1788761293833,"version":"build-2803163510"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Transplant."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Many potential organ donors are not referred to the transplant coordination, constituting potential missed referrals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u201cactual donor\u201d, \u201cmedical refusal\u201d, \u201cpersonal refusal\u201d, or \u201cpotential missed referral\u201d. The primary outcome was the potential missed referral rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frtra.2026.1924053","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:33:23Z","timestamp":1788759203000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Potential missed opportunities for organ donation: incidence and risk factors for non-referral among critically ill patients"],"prefix":"10.3389","volume":"5","author":[{"given":"Leda","family":"Nobile","sequence":"first","affiliation":[{"name":"Department of Intensive Care, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB)","place":["Brussels, Belgium"]},{"name":"Transplantation Unit, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB)","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Faso","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB)","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaia","family":"Furlan","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB)","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Annoni","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB)","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Labb\u00e9","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB)","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi","family":"Mezidi","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB)","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Lucidi","sequence":"additional","affiliation":[{"name":"Transplantation Unit, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB)","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Gustot","sequence":"additional","affiliation":[{"name":"Transplantation Unit, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB)","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Louis","family":"Vincent","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB)","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio Silvio","family":"Taccone","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB)","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1038\/s41581-021-00425-3","article-title":"Organ donation and transplantation: a multi-stakeholder call to action","volume":"17","author":"Vanholder","year":"2021","journal-title":"Nat Rev Nephrol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1080\/17843286.2016.1216259","article-title":"Recommendations for further improvement of the deceased organ donation process in Belgium","volume":"71","author":"Hoste","year":"2016","journal-title":"Acta Clin Belg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1001\/jamaneurol.2014.3083","article-title":"Worldwide barriers to organ donation","volume":"72","author":"Da Silva","year":"2015","journal-title":"JAMA Neurol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1007\/s00134-015-4191-5","article-title":"Organ donation in adults: a critical care perspective","volume":"42","author":"Citerio","year":"2016","journal-title":"Intensive Care Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1111\/j.1432-2277.2011.01243.x","article-title":"The critical pathway for deceased donation: reportable uniformity in the approach to deceased donation: critical pathway of deceased donation","volume":"24","author":"Dom\u00ednguez-Gil","year":"2011","journal-title":"Transpl Int"},{"key":"B6","volume-title":"Guide to the Quality and Safety of Organs for Transplantation","year":"2025"},{"key":"B7","year":"2011"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e2526067","DOI":"10.1001\/jamanetworkopen.2025.26067","article-title":"Donation physician specialists and missed organ donation opportunities","volume":"8","author":"Kramer","year":"2025","journal-title":"JAMA Netw Open"},{"key":"B9","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1097\/CCM.0000000000006950","article-title":"Missed organ donation opportunities in patients with devastating brain injury: a prospective population-based cohort study","volume":"54","author":"Kramer","year":"2026","journal-title":"Crit Care Med"},{"key":"B10","year":"2012"},{"key":"B11","year":""},{"key":"B12","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"Von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"3385","DOI":"10.1161\/01.CIR.0000147236.85306.15","article-title":"Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Fesuscitation Councils of Southern Africa)","volume":"110","author":"Jacobs","year":"2004","journal-title":"Circulation"},{"key":"B14","doi-asserted-by":"publisher","first-page":"3138","DOI":"10.1016\/j.transproceed.2014.09.169","article-title":"Belgian modified classification of Maastricht for donors after circulatory death","volume":"46","author":"Evrard","year":"2014","journal-title":"Transplant Proc"},{"key":"B15","volume-title":"Guide to the Quality and Safety of Organs for Transplantation","year":"2022"},{"key":"B16","year":"2012"},{"key":"B17","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction\/failure","volume":"22","author":"Vincent","year":"1996","journal-title":"Intensive Care Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1007\/s00134-005-2763-5","article-title":"SAPS 3\u2014from Evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission","volume":"31","author":"Moreno","year":"2005","journal-title":"Intensive Care Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1001\/jama.2020.11586","article-title":"Determination of brain death\/death by neurologic criteria: the world brain death project","volume":"324","author":"Greer","year":"2020","journal-title":"JAMA"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1726","DOI":"10.1056\/NEJMra1208943","article-title":"Circulatory shock","volume":"369","author":"Vincent","year":"2013","journal-title":"N Engl J Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2526","DOI":"10.1001\/jama.2012.5669","article-title":"Acute respiratory distress syndrome: the Berlin definition","volume":"307","author":"Ranieri","year":"2012","journal-title":"JAMA"},{"key":"B22","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1007\/s12630-023-02399-1","article-title":"Preventable harm in the Canadian organ donation and transplantation system: a descriptive study of missed organ donor identification and referral","volume":"70","author":"Zavalkoff","year":"2023","journal-title":"Can J Anesth Can Anesth"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1111\/ajt.14104","article-title":"How Spain reached 40 deceased organ donors per million population","volume":"17","author":"Matesanz","year":"2017","journal-title":"Am J Transplant"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1111\/ajt.16899","article-title":"Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: outcomes and risk factors for graft loss","volume":"22","author":"Hessheimer","year":"2022","journal-title":"Am J Transplant"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2019","DOI":"10.1111\/tri.13951","article-title":"Consensus statement on normothermic regional perfusion in donation after circulatory death: report from the European society for organ Transplantation's Transplant learning journey","volume":"34","author":"Jochmans","year":"2021","journal-title":"Transpl Int"},{"key":"B26","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1007\/s12028-015-0137-6","article-title":"Recommendations for the critical care management of devastating brain injury: prognostication, psychosocial, and ethical management: a position statement for healthcare professionals from the neurocritical care society","volume":"23","author":"Souter","year":"2015","journal-title":"Neurocrit Care"},{"key":"B27","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1007\/s12028-022-01545-9","article-title":"Revisiting the timeline of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: toward a temporal risk profile","volume":"37","author":"Schmidt","year":"2022","journal-title":"Neurocrit Care"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1972","DOI":"10.1007\/s00134-013-3043-4","article-title":"Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort","volume":"39","author":"Lemiale","year":"2013","journal-title":"Intensive Care Med"},{"key":"B29","year":""},{"key":"B30","year":""},{"key":"B31","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1111\/j.1432-2277.1999.tb00601.x","article-title":"The European donor hospital education programme (EDHEP): addressing the training needs of doctors and nurses who break bad news, care for the bereaved, and request donation","volume":"12","author":"Blok","year":"1999","journal-title":"Transpl Int"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2751","DOI":"10.1016\/j.transproceed.2006.08.155","article-title":"Training for doctors and nurses to deal with bereaved relatives after a sudden death. Evaluation of the European donor hospital education programme (EDHEP) in Germany","volume":"38","author":"Muthny","year":"2006","journal-title":"Transplant Proc"},{"key":"B33","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1177\/0310057X0002800210","article-title":"The European donor hospital education programme (EDHEP): enhancing communication skills with bereaved relatives","volume":"28","author":"Morton","year":"2000","journal-title":"Anaesth Intensive Care"}],"container-title":["Frontiers in Transplantation"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frtra.2026.1924053\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:33:24Z","timestamp":1788759204000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frtra.2026.1924053\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":33,"alternative-id":["10.3389\/frtra.2026.1924053"],"URL":"https:\/\/doi.org\/10.3389\/frtra.2026.1924053","relation":{},"ISSN":["2813-2440"],"issn-type":[{"value":"2813-2440","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]},"article-number":"1924053"}}