Abstract

Objective:

The aim of this study was to investigate the progression of brain death in close follow-up of comatose patients in intensive care unit (ICU), to reveal the data on epidemiological and clinical characteristics of brain death diagnosis process and the importance of timing of different stages of current procedures.

Materials and Methods:

This study was planned as a single-center, prospective, cross-sectional study. Patients who were treated in ICU between 2015-2017 and who were diagnosed as Glasgow Coma score <8 without sedation were included in the study.

Results:

Of the 79 patients diagnosed with brain death, 34 (43%) of their families provided consent for organ donation. However, only 26 (32.9%) of these patients actually became donors. The group that consented for organ donation had a significantly shorter time period between the declaration of brain death and the interview with the patient families about organ donation (median 12.5 minutes, 5-60 minutes) than the group that did not consent for organ donation (median 30 minutes, 2-60 minutes) (p=0.019).

Conclusion:

We believe that it is possible to increase organ donation rates by carefully monitoring the patients with low coma score as they progress to brain death in intensive care units, providing detailed information to families and conducting organ donation interview with the family as soon as possible after brain death notification.

Keywords: Brain death, declaration, intensive care unit, organ donation, Turkey

References

  1. Harmanci Seren AK, Yavuz H. Numbers of brain deaths and deceased donors in hospitals in istanbul region that have transplantation units: A retrospective analysis between the years 2005 and 2015. Transplant Proc 2017;49:392-5.
  2. Citerio G, Cypel M, Dobb GJ, Dominguez-Gil B, Frontera JA, Greer DM, et al. Organ donation in adults: a critical care perspective. Intensive Care Med 2016;42:305-15.
  3. Halevy A, Brody B. Brain death: reconciling definitions, criteria, and tests. Ann Intern Med 1993;119:519-25.
  4. Kahveci E. Donör tespit sistemi ve klinik değerlendirme. In: Kahveci E, Bozoklar AC, Topçuoğlu MA, editors. Ankara: Kayıhan ajans; 2015.
  5. Arsava EM, Topçuoğlu MA. Beyin ölümü tanısı: Klinik ve laboratuvar. In: Kahveci E, Bozoklar AC, Topçuoğlu MA, editors. Ankara: Kayıhan ajans; 2015.
  6. Maciel CB, Greer DM. ICU Management of the potential organ donor: state of the art. Curr Neurol Neurosci Rep 2016;16:86.
  7. Pirat A, Zeyneloğlu P. Donör bakımı. In: Kahveci E, Bozoklar AC, Topçuoğlu MA, editors. Ankara: Kayıhan ajans; 2015.
  8. Bodi MA, Pont T, Sandiumenge A, Oliver E, Gener J, Badia M, et al. BDorgan donation potential and life support therapy limitation in neurocritical patients. Med Intensiva 2015;39:337-44.
  9. Escudero D, Valentin MO, Escalante JL, Sanmartin A, Perez-Basterrechea M, de Gea J, et al. Intensive care practices in BDdiagnosis and organ donation. Anaesthesia 2015;70:1130-9.
  10. Senouci K, Guerrini P, Diene E, Atinault A, Claquin J, Bonnet F, et al. A survey on patients admitted in severe coma: implications for BDidentification and organ donation. Intensive Care Med 2004;30:38-44.
  11. Aksoy İ, Pehlivanlar Küçük M, Öztürk ÇE, Baydın A. Early detection of brain damage in emergency department and the organ donation process: a case series. Eur Res J 2018;4:411-5
  12. Yücetin L. Aile ile görüşme ve izin alınması. In: Yücetin L, editor. Antalya; 2007.
  13. Arslan A, Dilek A. Family perception and communication in organ donation from cadaver. Turk Neph Dial Transpl 2017;26:147-53.
  14. Sadegh Beigee F, Mohsenzadeh M, Shahryari S, Mojtabaee M. Role of more active identification of brain-dead cases in increasing organ donation. Exp Clin Transplant 2017;15(Suppl 1):60-2.
  15. de Groot YJ, Jansen NE, Bakker J, Kuiper MA, Aerdts S, Maas AI, et al. Imminent brain death: point of departure for potential heart-beating organ donor recognition. Intensive Care Med 2010;36:1488-94.
  16. Birtan D, Arslantas MK, Dincer PC, Altun GT, Bilgili B, Ucar FB, et al. Effect of Interviews Done by Intensive Care Physicians on Organ Donation. Transplant Proc 2017;49:396-8.
  17. Kompanje EJ, de Groot YJ, Bakker J. Is organ donation from brain dead donors reaching an inescapable and desirable nadir? Transplantation 2011;91:1177-80.
  18. Organ ve doku hizmetleri yönetmeliği, 28191. (01.02.2012 ). Bağlantı adresi: https://www.resmigazete.gov.tr/eskiler/2012/02/20120201-4.htm Resmî Gazete: 28191
  19. Ekemen S. Brain death. Turkiye Klinikleri J Anest Reanim-Special Topics 2009;2:1-7.
  20. Ünal A, Dora B. Transcranial Doppler ultransonography as a confirmative diagnostic test in brain death. Turk J Cerebrovasc Dis 2012;18:49-59.
  21. Bugge JF. BDand its implications for management of the potential organ donor. Acta Anaesthesiol Scand 2009;53:1239-50.
  22. DuBose J, Salim A. Aggressive organ donor management protocol. J Intensive Care Med 2008;23:367-75.
  23. Dosemeci L, Yilmaz M, Cengiz M, Dora B, Ramazanoglu A. Brain death and donor management in the intensive care unit: experiences over the last 3 years. Transplant Proc 2004;36:20-1.
  24. Dujardin KS, McCully RB, Wijdicks EF, Tazelaar HD, Seward JB, McGregor CG, et al. Myocardial dysfunction associated with brain death: clinical, echocardiographic, and pathologic features. J Heart Lung Transplant 2001;20:350-7.
  25. Gramm HJ, Meinhold H, Bickel U, Zimmermann J, von Hammerstein B, Keller F, et al. Acute endocrine failure after brain death? Transplantation. 1992;54:851-7.
  26. Kıraklı C, Uçar ZZ, Anıl AB, Özbek İ. The effect of shortening confi rmed BDdiagnosis time on organ donation rates in the intensive care unit. Turk J Intensive Care 2011;1:11.
  27. Salim A, Martin M, Brown C, Rhee P, Demetriades D, Belzberg H. The effect of a protocol of aggressive donor management: Implications for the national organ donor shortage. J Trauma 2006;61:429-33.
  28. Smith M. Physiologic changes during brain stem death--lessons for management of the organ donor. J Heart Lung Transplant 2004;23(Suppl 9):S217-22.
  29. Wood KE, Becker BN, McCartney JG, D’Alessandro AM, Coursin DB. Care of the potential organ donor. N Engl J Med 2004;351:2730-9.
  30. Cuende N, Canon JF, Alonso M, Delagebasala CM, Sagredo E, Miranda B. [Quality assurance program in the process of donation and transplantation at the National Organization of Transplantations]. Nefrologia 2001;21(Suppl 4):65-76.
  31. Hakeri H. Tıp hukuku. 10 ed. Ankara: Seçkin Yayıncılık; 2015:370-84.

Copyright and license

Copyright © 2020 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Öztürk ÇE, Pehlivanlar Küçük M, Eyüpoğlu S, Yüksel Ü, Ülger F. Evaluation of Organ Donation Rates Among in Patients with Anticipated Imminent Brain Death. Turk J Intensive Care. 2020;18(4):205-212. https://doi.org/10.4274/tybd.galenos.2019.43255