To our knowledge, the present study is the largest study describing the use of serial TTE and its utilization in adult donors. The prevalence of cardiac dysfunction after adult brain death is high, but given enough time and support, many of these donors have improvement in cardiac function, ultimately leading to transplantation.

Background Cardiac dysfunction has been reported to occur in as much as 42% of adults with brain death, and may limit cardiac donation after brain death. Knowledge of the prevalence and natural course of cardiac dysfunction after brain death may help to improve screening and transplant practices but adequately sized studies in pediatric brain death are lacking. The aims of our study are to describe the prevalence and course of cardiac dysfunction after pediatric brain death. Methods We conducted a cross-sectional study using an organ procurement organization database (Life Center Northwest) of potential pediatric cardiac donors diagnosed with brain death between January 2011 and November 2013. Transthoracic echocardiograms (TTEs) were reviewed for cardiac dysfunction [defined as ejection fraction (EF) < 50% or the presence of regional wall motion abnormalities (RWMAs)]. Descriptive statistics were used to analyze clinical characteristics and describe longitudinal echocardiogram findings in a subgroup of patients. We examined for heterogeneity between cardiac dysfunction with respect to cause of brain death. Results We identified 60 potential pediatric cardiac donors (age ≤ 18 years) with at least one TTE following brain death. Cardiac dysfunction was present in 23 (38%) patients with brain death. Mean EF (37.6% vs. 62.2%) and proportion of procured hearts (56.5% vs. 83.8%) differed significantly between the groups with and without cardiac dysfunction, respectively. Of the 11 subjects with serial TTE data, the majority (73%) of patients with cardiac dysfunction improved over time, leading to organ procurement. No heterogeneity between cardiac dysfunction and particular causes of brain death was observed. Conclusion The frequency of cardiac dysfunction in children with brain death is high. Serial TTEs in patients with cardiac dysfunction showed improvement of cardiac function in most patients, suggesting that initial decisions to procure should not solely depend on the initial TTE exam results.