Donor conversion rates depend on the assessment tools used in the evaluation of potential organ donors

Abstract

PurposeIt is desirable to identify a potential organ donor (POD) as early as possible to achieve a donor conversion rate (DCR) as high as possible which is defined as the actual number of organ donors divided by the number of patients who are regarded as a potential organ donor. The DCR is calculated with different assessment tools to identify a POD. Obviously, with different assessment tools, one may calculate different DCRs, which make comparison difficult. Our aim was to determine which assessment tool can be used for a realistic estimation of a POD pool and how they compare to each other with regard to DCR. MethodsRetrospective chart review of patients diagnosed with a subarachnoid haemorrhage, traumatic brain injury or intracerebral haemorrhage. We applied three different assessment tools on this cohort of patients.ResultsWe identified a cohort of 564 patients diagnosed with a subarachnoid haemorrhage, traumatic brain injury or intracerebral haemorrhage of whom 179/564 (31.7%) died. After applying the three different assessment tools the number of patients, before exclusion of medical reasons or age, was 76 for the IBD-FOUR definition, 104 patients for the IBD-GCS definition and 107 patients based on the OPTN definition of imminent neurological death. We noted the highest DCR (36.5%) in the IBD-FOUR definition.ConclusionThe definition of imminent brain death based on the FOUR-score is the most practical tool to identify patients with a realistic chance to become brain dead and therefore to identify the patients most likely to become POD.

Prediction of evolution toward brain death upon admission to ICU in comatose patients with spontaneous intracerebral hemorrhage using simple signs

“…All current proposed definitions of imminent BD are based on the loss of brainstem reflexes [17,18]. Of the set of brainstem reflexes tested upon admission, we found that the abolition of corneal reflexes was most predictive of BD, and that its predictive value did not differ according to whether the ICH was infratentorial.…”

“…Zurasky et al [10] found that patients with ICH who evolved to BD had a lower median admission Glasgow Coma Scale score (without defining a threshold), and that AfricanAmerican patients evolved more often to BD and were less concerned by early decisions to withdraw life support. Some experts have recently proposed definitions of imminent BD based on abolished brain stem responses [17,18]. Recently, analyzing patients who died on an ICU in Dutch university hospitals, it has been reported that 45.6% of patients with imminent BD actually evolved toward BD [19].…”

“…To better identify potential organ donors, some experts have recently proposed definitions of "imminent BD" [17,18]. In a retrospective cohort of patients who died from ICH, aneurysmal subarachnoid hemorrhage, or traumatic brain injury, a third of patients who fulfilled the criteria for "imminent BD" were ultimately organ donors after BD [18].…”

“…In a retrospective cohort of patients who died from ICH, aneurysmal subarachnoid hemorrhage, or traumatic brain injury, a third of patients who fulfilled the criteria for "imminent BD" were ultimately organ donors after BD [18]. However, other patients who died as result of BD, but did not become organ donors were not reported.…”

‘In plain language’: uniform criteria for organ donor recognition

“…1) [5]. In a retrospective chart analysis, IBD proved to be the most practical tool to identify patients with a realistic chance to become brain dead, and therefore to identify patients most likely to become organ donors [6]. It is essential that all researchers use the same definition for potential organ donor recognition.…”