Progression of Organ Failure in Patients Approaching Brain Stem Death

Lytle, Francis; Afessa, Bekele; Keegan, Mark T.

doi:10.1111/j.1600-6143.2009.02575.x

Cited by 16 publications

(13 citation statements)

References 32 publications

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“…128 Prolonged management of the brain dead is not necessarily associated with reduction in organs retrieved 129 or worsening organ failure scores and no organ seems particularly vulnerable to loss. 130 The actual timing of retrieval depends on which organs are likely to be retrieved, and whether other organs will be transplanted even if function improves. A prolonged cold ischaemic time certainly has an adverse effect on the function of all transplanted organs, particularly hearts.…”

Section: Duration Of Donor Managementmentioning

confidence: 99%

Management of the heartbeating brain-dead organ donor

McKeown

Bonser

Kellum

2012

British Journal of Anaesthesia

213

177

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The main factor limiting organ donation is the availability of suitable donors and organs. Currently, most transplants follow multiple organ retrieval from heartbeating brain-dead organ donors. However, brain death is often associated with marked physiological instability, which, if not managed, can lead to deterioration in organ function before retrieval. In some cases, this prevents successful donation. There is increasing evidence that moderation of these pathophysiological changes by active management in Intensive Care maintains organ function, thereby increasing the number and functional quality of organs available for transplantation. This strategy of active donor management requires an alteration of philosophy and therapy on the part of the intensive care unit clinicians and has significant resource implications if it is to be delivered reliably and safely. Despite increasing consensus over donor management protocols, many of their components have not yet been subjected to controlled evaluation. Hence the optimal combinations of treatment goals, monitoring, and specific therapies have not yet been fully defined. More research into the component techniques is needed.

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Section: Duration Of Donor Managementmentioning

confidence: 99%

Management of the heartbeating brain-dead organ donor

McKeown

Bonser

Kellum

2012

British Journal of Anaesthesia

213

177

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“…These patients sustained serious neurological damage but retained one or more brainstem reflexes (one patient was ventilated on pressure support settings and two patients had positive cornea reflexes) and were excluded by the application of the IBD-FOUR definition. The IBD-FOUR definition showed the highest DCR of 36.5%, which is still low when compared to other published DCRs [1, 16, 17]. As stated before, comparison is difficult with different definitions of a POD.…”

Section: Discussionmentioning

confidence: 76%

“…The DCR is defined as the actual number of organ donors divided by the number of patients who are regarded as PODs. Organ procurement organisations in the USA aim to achieve a DCR of at least 75% [15], but the actual DCRs in the USA, UK and Germany are estimated to be in the range of 42–68% [1, 16–18]. However, using a DCR has practical limitations.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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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.

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“…19 However, Lytle et al showed that organ failure scores did not significantly progress during the intensive care unit course of organ donors, implying that prolonged periods of time to organ retrieval were not as detrimental. 15 …”

Section: Discussionmentioning

confidence: 99%

“…In comparison to Lytle et al , our median time to declaration was much longer, 11.8 hours versus 45.4 hours. 15 This may be a reflection of single-center data being compared to multi-center data. As each institution has its own declaration of DNC protocols, required waiting periods and staff availability, AtoD times can be dramatically affected.…”

Section: Discussionmentioning

confidence: 99%

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

Resnick

Seamon

Holena

et al. 2017

Journal of Surgical Research

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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.

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Progression of Organ Failure in Patients Approaching Brain Stem Death

Cited by 16 publications

References 32 publications

Management of the heartbeating brain-dead organ donor

Management of the heartbeating brain-dead organ donor

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

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

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