Enhancement of Corneal Donation through Collaboration between Accident and Emergency Department (A&E) and the Hospital Authority Eye Bank in Hong Kong East Cluster

Abstract Description

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Authors (including presenting author) :

Yuen MSY (1), Hsu THC (2), Leung JKS (1), Kan PG (3), Chee, PPY (4), Wong V (2), Wong C (2), Lau PF (1), Leung CP (3), Law A (4)

Affiliation :

(1) Department of Accident and Emergency, Pamela Youde Nethersole Eastern Hospital (2) Hospital Authority Eye Bank (3) Department of Accident and Emergency, Ruthonjee Tang Shiu Kin Hospitals (4) Department of Accident and Emergency, St. John Hospital

Introduction :

Corneal donation involved donating the corneas. The cornea transplant could give recipients back the gift of sight. The sooner the donation takes place, the better the transplant outcome. The cornea can be donated up to 12 hours after the donor die. For years, the corneal donation number was low (6 in 2017) in the Hong Kong East Cluster.

Objectives :

To report on the implementation of the enhancement measures in A&E

Methodology :

Patients who were certified dead in the A&E would be screened for corneal donation by the A&E Physicians or Nurses. The criteria are fulfilled if the potential donor is positive in the followings: 1.Age is less than 80 and 2.Certified death within the period of 0000 to 1700 on Monday to Friday except public holiday. They will be excluded if present with unknown identity, susceptible to potential complaint and relative do not accept the death of potential donor. Eye coordinator would be informed of the death of potential donor and prepared to offer bereavement support to the relatives. Eye preservation would be done by instilling normal saline to the eyes. The corneal harvest would be arranged at public mortuary. To prepare for the above implementation, staff education was duly carried out in cluster A&E. Staffs began to record the dead and select potential donors. Nurse Consultant and Eye Coordinator devised the workflow; opinions were sought from departments and handover mechanism of selected donor enhanced. Barriers to implementation were overcome in trial-run period in Pamela Youde Nethersole Eastern Hospital and prospective audit carried out in the formal implementation period.

Result & Outcome :

748 patients were certified dead in the cluster A&E from January 1st to December 31st 2018, in which 27 (3.6%) fulfilled the criteria and referred to Eye Coordinator. Out of these 27 patients, 14 patients had corneas harvested. Workload was regards as acceptable from staff survey and Eye Coordinator. Implementation was smooth and new measures of corneal donation were welcomed by departments (A&E Staff: Bereavement was provided to relatives by Eye Coordinator, Cornea harvest was performed at Public Mortuary and Conflict of interest issues was addressed, Increased in contribution to corneal donation. Eye Coordinator: Notification of time of dead of potential donor was shortened and Interaction time with relatives was advanced). In Conclusion, through collaboration between A&E and the Hospital Authority Eye Bank, the enhancement measures were feasible and resulted in significant improvement in the overall corneal donation number in cluster A&E.