An underrecognized source of organ donors: patients with brain death after successfully resuscitated cardiac arrest

Adrie, Christophe; Haouache, Hakim; Saleh, Meylan; Mémain, N.; Laurent, Isabelle; Thuong, Marie; Darques, Loic; Guerrini, P.; Monchi, Mehran

doi:10.1007/s00134-007-0885-7

Cited by 97 publications

(61 citation statements)

References 25 publications

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“…[28][29][30] Authors of previous small studies have assessed organ injury in brain-dead donors who experienced cardiac arrest. [31][32][33][34] Those with anoxic brain injury were generally reported to have greater hemodynamic instability and higher liver enzymes, and fewer organs were procured from these donors. However, outcomes in recipients of organs from donors with anoxic brain injury were not necessarily worse than with other diagnoses.…”

Section: Discussionmentioning

confidence: 99%

Time trends in organ donation after neurologic determination of death: a cohort study

2017

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Background:The cause of brain injury may influence the number of organs that can be procured and transplanted with donation following neurologic determination of death. We investigated whether the distribution of causes responsible for neurologic death has changed over time and, if so, whether this has had an impact on organ quality, transplantation rates and recipient outcomes. Methods:We performed a cohort study involving consecutive brain-dead organ donors in southern Alberta between 2003 and 2014. For each donor, we determined last available measures of organ injury and number of organs transplanted, and compared these variables for various causes of neurologic death. We compared trends to national Canadian data for 2000-2013 (2000-2011 for Quebec).Results: There were 226 brain-dead organ donors over the study period, of whom 100 (44.2%) had anoxic brain injury, 63 (27.9%) had stroke, and 51 (22.6%) had traumatic brain injury. The relative proportion of donors with traumatic brain injury decreased over time (> 30% in 2003-2005 v. 6%-23% in 2012-2014) (p = 0.004), whereas that with anoxic brain injury increased (14%-37% v. 46%-80%, respectively) (p < 0.001). Nationally, the annual number of brain-dead donors with traumatic brain injury decreased from 4.4 to less than 3 per million population between 2000 and 2013, and that with anoxic brain injury increased from 1.1 to 3.1 per million. Donors with anoxic brain injury had higher concentrations of creatinine, alanine aminotransferase and troponin T, and lower P a O 2 /F I O 2 and urine output than donors with other diagnoses. The average number of organs transplanted per donor was 3.6 with anoxic brain injury versus 4.5 with traumatic brain injury or stroke (p = 0.002).Interpretation: Anoxic brain injury has become a leading cause of organ donation after neurologic determination of death in Canada. Organs from donors with anoxic brain injury have a greater degree of injury, and fewer are transplanted. These findings have implications for availability of organs for transplantation in patients with end-stage organ failure. AbstractResearch Research CMAJ OPEN E20CMAJ OPEN, 5(1)We performed a cohort study among consecutive braindead donors in southern Alberta to determine whether the distribution of causes responsible for neurologic death has changed (primary outcome) and, if so, whether this has had an impact on organ quality, transplantation rates and recipient outcomes (secondary outcomes). Using data from the Canadian Institute of Health Information (CIHI), we also assessed trends in the cause of neurologic death and number of organs transplanted per donor across Canada. Methods SettingA comprehensive clinical information system (ALTRABase) is used to manage all organ donation referrals in southern Alberta and enables linkage of donor and recipient data. Donor management is in accordance with national guidelines, which are incorporated directly into a region-wide electronic order set. 18 In every case, solid organs are routinely offered to transplantation ...

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Section: Discussionmentioning

confidence: 99%

Time trends in organ donation after neurologic determination of death: a cohort study

2017

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“…Successful use of lung allografts after cardiac arrest in the donor raises the possibility of further expanding the donor pool. Patients suffering out-of-hospital cardiac arrest have been hypothesized to represent an underused source of organ donors (8,9). Many of these patients have care withdrawn at early stages, potentially precluding evolution to brain death (8,14,15).…”

Section: Discussionmentioning

confidence: 99%

“…Patients suffering out-of-hospital cardiac arrest have been hypothesized to represent an underused source of organ donors (8,9). Many of these patients have care withdrawn at early stages, potentially precluding evolution to brain death (8,14,15). Moreover, concern persists regarding the suitability of such organs because of potential ischemic injury (20).…”

Section: Discussionmentioning

confidence: 99%

“…Adult patients who progress to brain death after resuscitation from cardiac arrest have been hypothesized to represent an underused source of potential organ donors (8)(9)(10). Approximately 450,000 Americans have a cardiac arrest each year (11), of which approximately 5-10% will be resuscitated with return of spontaneous circulation (12), and 8-16% of those (or approximately 1,800-7,200 patients) will result in brain death (13).…”

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confidence: 99%

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Use of Lung Allografts from Brain-Dead Donors after Cardiopulmonary Arrest and Resuscitation

Castleberry¹,

Worni

Osho

et al. 2013

Am J Respir Crit Care Med

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Rationale: Patients who progress to brain death after resuscitation from cardiac arrest have been hypothesized to represent an underused source of potential organ donors; however, there is a paucity of data regarding the viability of lung allografts after a period of cardiac arrest in the donor. Objectives: To analyze postoperative complications and survival after lung transplant from brain-dead donors resuscitated after cardiac arrest. Methods: The United Network for Organ Sharing database records donors with cardiac arrest occurring after brain death. Adult recipients of lung allografts from these arrest/resuscitation donors between 2005 and 2011 were compared with nonarrest donors. Propensity score matching was used to reduce the effect of confounding. Postoperative complications and overall survival were assessed using McNemar's test for correlated binary proportions and Kaplan-Meier methods. Measurements and Main Results: A total of 479 lung transplant recipients from arrest/resuscitation donors were 1:1 propensity matched from a cohort of 9,076 control subjects. Baseline characteristics in the 1:1-matched cohort were balanced. There was no significant difference in perioperative mortality, airway dehiscence, dialysis requirement, postoperative length of stay (P > 0.38 for all), or overall survival (P ¼ 0.52). A subanalysis of the donor arrest group demonstrated similar survival when stratified by resuscitation time quartile (P ¼ 0.38). Conclusions: There is no evidence of inferior outcomes after lung transplant from brain-dead donors who have had a period of cardiac arrest provided that good lung function is preserved and the donor is otherwise deemed acceptable for transplantation. Potential expansion of the donor pool to include cardiac arrest as the cause of brain death requires further study.

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“…Evidence (36)(37)(38)(39) suggests that functional outcomes of organs from patients deemed to be brain dead as a result of cardiac arrest are not signifi cantly different from those of donors who are brain dead due to causes other than cardiac arrest. Many factors, including medical, social, cultural, legal and ethical issues, need to be considered when embarking on a programme of using viable organs from patients who are brain dead as a result of cardiac arrest.…”

Section: Organ Donationmentioning

confidence: 99%

Advanced Cardiac Life Support: 2016 Singapore Guidelines

Ching

Leong

Chua

et al. 2017

smedj

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Public access defibrillation PAD is another key intervention to improve the time to defi brillation for shockable rhythms in OHCA, through increasing the availability of automated external defi brillators (AEDs) in public places. Patients with shockable rhythms who received bystander defibrillation had 5.8 times the odds of survival compared to those who did not. Emergency ambulance response Prehospital emergency medical services should optimise the rapid dispatch of fi rst-responders who are trained in Basic Cardiac Life Support (BCLS) and AED use, as well as paramedics trained in advanced life support protocols, to the scene within eight minutes. This can be achieved through strategic preplacement of ambulances and related vehicular assets, as well as stratifi ed levels of responses for calls of different priority levels.Survival in OHCA is critically dependent on prompt institution of the fi rst three links of the chain of survival. Prehospital factors, including witnessed arrests, initial shockable rhythms, bystander defi brillation and emergency ambulance response times within eight minutes of collapse, have been ABSTRACT The main areas of emphasis in the Advanced Cardiac Life Support (ACLS) guidelines are: early recognition of cardiac arrest and call for help; good-quality chest compressions; early defi brillation when applicable; early administration of drugs; appropriate airway management ensuring normoventilation; and delivery of appropriate post-resuscitation care to enhance survival. Of note, it is important to monitor the quality of the various care procedures. The resuscitation team needs to reduce unnecessary interruptions to chest compressions in order to maintain adequate coronary perfusion pressure during the ACLS drill. In addition, the team needs to continually look out for reversible causes of the cardiac arrest.

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An underrecognized source of organ donors: patients with brain death after successfully resuscitated cardiac arrest

Abstract: Brain death may occur in about one-sixth of patients after successfully resuscitated OHCA, creating opportunities for organ donation.

Cited by 97 publications

References 25 publications

Time trends in organ donation after neurologic determination of death: a cohort study

Time trends in organ donation after neurologic determination of death: a cohort study

Use of Lung Allografts from Brain-Dead Donors after Cardiopulmonary Arrest and Resuscitation

Advanced Cardiac Life Support: 2016 Singapore Guidelines

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