Brain death organ donation potential and life support therapy limitation in neurocritical patients

Bodí, M.; Pont, T.; Sandiumenge, Alberto; Oliver, E.; Gener, J.; Badía, Mariona; Mestre, J.; Muñoz, E.; Esquirol, X.; Llauradó, M.; Twose, Jorge; Quintana, Salvador

doi:10.1016/j.medine.2014.07.001

Cited by 7 publications

(8 citation statements)

References 24 publications

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“…(4) In their multi-centered intensive care study, Bodi et al reported that brain death occurred mostly in patients with hemorrhagic stroke and traumatic brain injury. (8) In another multi-centered intensive care study, Senouci et al reported that cerebrovascular accident and trauma were the most frequent causes of brain death(10); a study from Spain noted similar results. (9) On the contrary, in a study from Holland, Kompanje et al found that subarachnoid hemorrhage was the most common cause of brain death.…”

Section: Discussionmentioning

confidence: 90%

“…Further, patients with brain death had significantly lower APACHE II scores at the time of ICU admission [median 18 (10-36)] compared to patients who died without BD [median 19 (8-32)] (p=0.011). However, there were no significant differences between patients with and without BD regarding SOFA scores assessed 24 hours after ICU admission [9 (4-17) vs. 9 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), respectively] (p=0.238). The time between ICU admission and the time the GCS score decreased to 3 was 16 (0-336) hours in the group that consented for organ donation and 24 (0-192) hours in the group that did not consent for organ donation; this difference was not significant (p=0.547).…”

Section: Statistical Evaluation Of Patients With Brain Deathmentioning

confidence: 91%

“…For those patients whose families did not consent for organ donation, the time until cardiac arrest was a median of 6 (1-16) hours. For those patients whose families did consent for organ donation, the time until organ retrieval was a median of 7 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) hours.…”

Section: Statistical Evaluation Of Patients With Brain Deathmentioning

confidence: 99%

“…(7) There are a limited number of studies related to the follow-up of comatose patients in association with brain death and the organ donation process. (8)(9)(10) Although several clinics have published BD reports,(11) ICUs remain the major contributor to the organ pool, as they are best able to follow-up with patients with low GCS. The current study closely monitored comatose ICU patients in order to investigate their progression to brain death.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Organ Donation Rates Among in Patients with Anticipated Imminent Brain Death

Öztürk¹,

Küçük²,

Eyüpoğlu³

et al. 2020

tybd

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Bu çalışmada; yoğun bakımda izlenen komatöz hastaların yakın takibi ile beyin ölümüne gidiş sürecinin araştırılması, beyin ölümü tanı sürecindeki epidemiyolojik ve klinik özellikler, mevcut prosedürlerin farklı aşamalarındaki zamanlamanın önemi hakkında verilerin ortaya konulması amaçlanmıştır. Gereç ve Yöntem: Bu çalışma tek merkezli, prospektif, kesitsel bir çalışma olarak planlanmıştır, 2015-2017 tarihleri arasında Yoğun bakımda tedavi gören, sedasyon almaksızın nörolojik muayenesinde GKS<8 olarak tespit edilen hastalar çalışmaya dahil edilmiştir. Bulgular: Beyin ölümü tanısı alan 79 hastadan 34'ünün (% 43) ailesi organ bağışı için onay verebileceğini belirtti. Ancak, bu hastaların sadece 26'sı (% 32,9) gerçekten bağışçı oldu. Organ bağışını onaylanan grupta, beyin ölümü beyanıyla aile ile organ bağışı hakkında görüşme süresi [medyan 12.5 (5-60) dakika], organ bağışına izin vermeyen gruba göre daha kısa bir süreye sahipti [medyan 30 (2-60) dakika] (p = 0.019). Sonuç: Yoğun bakım ünitelerinde beyin ölümüne ilerlerken koma skoru düşük olan hastaların dikkatle izlenerek, ailelere ayrıntılı bilgi verilmesinin ve aile ile organ bağışı görüşmesinin beyin ölümü bildiriminden sonra en kısa sürede yapılmasının organ bağışı oranları arttırabileceği düşüncesindeyiz.

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Section: Discussionmentioning

confidence: 90%

Section: Statistical Evaluation Of Patients With Brain Deathmentioning

confidence: 91%

Section: Statistical Evaluation Of Patients With Brain Deathmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of Organ Donation Rates Among in Patients with Anticipated Imminent Brain Death

Öztürk¹,

Küçük²,

Eyüpoğlu³

et al. 2020

tybd

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“…Potencialidad de donación de órganos en muerte encefálica y limitación del tratamiento de soporte vital en los pacientes neurocríticos. (16) Bodí MA 2015 Dialnet La liberación de cortisol afecta a algunas situaciones de stress. Los pacientes con muerte encefálica no alcanzan el valor del cortisol de 18 ug/dl en 30 minutos se administrará corticoides.…”

Section: Títulounclassified

Brain death and organ and tissue donor management in the Intensive Care Unit

Jiménez

Vargas

Rodas

et al. 2022

Salud, Ciencia y Tecnología

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Introducción: La muerte encefálica se define como el cese irreversible de todas las funciones cerebrales y del tronco encefálico. El oportuno manejo y mantenimiento de estas funciones vitales y corrección de las alteraciones fisiopatológicas del potencial donante hacen posible la donación de órganos, brindando una segunda oportunidad a pacientes que dependen de un trasplante. Objetivo: Describir el concepto de muerte encefálica en el paciente y su manejo actual como potencial donante de órganos y tejidos en la unidad de cuidados intensivos. Metodología: Se desarrolló un estudio, no experimental, descriptivo, de tipo revisión bibliográfica.Resultados: El proceso de donación de órganos y tejidos posterior a muerte encefálica es un desafío en cuanto al diagnóstico y posterior manejo hemodinámico con el objetivo de mantener la perfusión de tejidos para que estos tengan vitalidad y viabilidad para ser trasplantados al paciente receptor.Conclusiones: Se recomienda utilizar un protocolo de muerte encefálica establecido y aplicarlo correctamente, para evitar problemas legales. Cuando ya se ha diagnosticado es posible realizar la evaluación para establecer si el paciente es candidato a donante o no. Los cambios fisiopatológicos que aparecen en el proceso de ME hacen que estos pacientes críticos sean manejados con cuidados extremos. El mantenimiento del donante es un desafío alto para todo el personal de salud en el área de cuidados intensivos, ya que su tratamiento es sumamente complejo y por otro lado la disponibilidad de donantes es limitada en comparación de la alta demanda de los pacientes receptores que esperan un órgano.

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Evidence-Based Checklist to Delay Cardiac Arrest in Brain-Dead Potential Organ Donors

Westphal,

Robinson,

Giordani

et al. 2023

JAMA Netw Open

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ImportanceThe effectiveness of goal-directed care to reduce loss of brain-dead potential donors to cardiac arrest is unclear.ObjectiveTo evaluate the effectiveness of an evidence-based, goal-directed checklist in the clinical management of brain-dead potential donors in the intensive care unit (ICU).Design, Setting, and ParticipantsThe Donation Network to Optimize Organ Recovery Study (DONORS) was an open-label, parallel-group cluster randomized clinical trial in Brazil. Enrollment and follow-up were conducted from June 20, 2017, to November 30, 2019. Hospital ICUs that reported 10 or more brain deaths in the previous 2 years were included. Consecutive brain-dead potential donors in the ICU aged 14 to 90 years with a condition consistent with brain death after the first clinical examination were enrolled. Participants were randomized to either the intervention group or the control group. The intention-to-treat data analysis was conducted from June 15 to August 30, 2020.InterventionsHospital staff in the intervention group were instructed to administer to brain-dead potential donors in the intervention group an evidence-based checklist with 13 clinical goals and 14 corresponding actions to guide care, every 6 hours, from study enrollment to organ retrieval. The control group provided or received usual care.Main Outcomes and MeasuresThe primary outcome was loss of brain-dead potential donors to cardiac arrest at the individual level. A prespecified sensitivity analysis assessed the effect of adherence to the checklist in the intervention group.ResultsAmong the 1771 brain-dead potential donors screened in 63 hospitals, 1535 were included. These patients included 673 males (59.2%) and had a median (IQR) age of 51 (36.3-62.0) years. The main cause of brain injury was stroke (877 [57.1%]), followed by trauma (485 [31.6%]). Of the 63 hospitals, 31 (49.2%) were assigned to the intervention group (743 [48.4%] brain-dead potential donors) and 32 (50.8%) to the control group (792 [51.6%] brain-dead potential donors). Seventy potential donors (9.4%) at intervention hospitals and 117 (14.8%) at control hospitals met the primary outcome (risk ratio [RR], 0.70; 95% CI, 0.46-1.08; P = .11). The primary outcome rate was lower in those with adherence higher than 79.0% than in the control group (5.3% vs 14.8%; RR, 0.41; 95% CI, 0.22-0.78; P = .006).Conclusions and RelevanceThis cluster randomized clinical trial was inconclusive in determining whether the overall use of an evidence-based, goal-directed checklist reduced brain-dead potential donor loss to cardiac arrest. The findings suggest that use of such a checklist has limited effectiveness without adherence to the actions recommended in this checklist.Trial RegistrationClinicalTrials.gov Identifier: NCT03179020

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Brain death organ donation potential and life support therapy limitation in neurocritical patients

Cited by 7 publications

References 24 publications

Evaluation of Organ Donation Rates Among in Patients with Anticipated Imminent Brain Death

Evaluation of Organ Donation Rates Among in Patients with Anticipated Imminent Brain Death

Brain death and organ and tissue donor management in the Intensive Care Unit

Evidence-Based Checklist to Delay Cardiac Arrest in Brain-Dead Potential Organ Donors

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