Early declaration of death by neurologic criteria results in greater organ donor potential

Abstract

Background Aggressive management of patients prior to and after determination of death by neurologic criteria (DNC) is necessary to optimize organ recovery, transplantation, and increase the number of organs transplanted per donor (OTPD). The effects of time management are understudied but potentially pivotal component. The objective of this study was to analyze specific time points (time to DNC, time to procurement) and the time intervals between them to better characterize the optimal timeline of organ donation. Methods Using data over a 5-year time period (2011–2015) from the largest US OPO, all patients with catastrophic brain injury and donated transplantable organs were retrospectively reviewed. Active smokers were excluded. Maximum donor potential was seven organs (heart, lungs [2], kidneys [2], liver, and pancreas). Time from admission to declaration of DNC and donation was calculated. Mean time points stratified by specific organ procurement rates and overall OTPD were compared using unpaired t-test. Results Of 1719 Declaration of Death by Neurologic Criteria organ donors, 381 were secondary to head trauma. Smokers and organs recovered but not transplanted were excluded leaving 297 patients. Males comprised 78.8%, the mean age was 36.0 (±16.8) years, and 87.6% were treated at a trauma center. Higher donor potential (>4 OTPD) was associated with shorter average times from admission to brain death; 66.6 versus 82.2 hours, P = 0.04. Lung donors were also associated with shorter average times from admission to brain death; 61.6 versus 83.6 hours, P = 0.004. The time interval from DNC to donation varied minimally among groups and did not affect donation rates. Conclusions A shorter time interval between admission and declaration of DNC was associated with increased OTPD, especially lungs. Further research to identify what role timing plays in the management of the potential organ donor and how that relates to donor management goals is needed.

Processo diagnóstico de morte encefálica e perfil dos doadores de órgãos e tecidos: Estudo de caso

“…Em estudo americano realizado com 297 vítimas de TCE diagnosticados com ME, entre 2011 e 2015, foi verificada uma relação inversa entre o número de órgãos doados e o tempo de internação até a retirada dos órgãos, que foi de 3,15 dias em média; semelhante ao estabelecido nesse estudo (3,18 dias) (Resnick, et al, 2017). O TCE e o AVC foram as enfermidades que mais frequentemente motivaram a internação, concordando com estudos prévios.…”

Analysis of brain death declaration process and its impact on organ donation in a reference trauma center

“…(17) A longer total BD declaration interval is associated with more cardiac arrests, (19) higher costs in intensive care and poor quality of organs designated for transplant, (20,21) and a shorter time interval between admission to BD declaration increases the number of organs transplanted per donor. (22) Also, cold ischemia time longer than 24 hours are associated with lower kidney graft survival. (23) Also, we must consider the great variability in the process of BD declaration worldwide.…”

Patient-centered practices in organ donation

“…Earlier declaration of brain death facilitates earlier donation‐centered management by the OPO, should the patient be an organ donor. This in turn is associated with a greater number of organs suitable for transplant for each donor . But appropriate declaration of death is necessary regardless of a patient's intent to donate his or her organs.…”