Advance directives and consent to organ donation in seven university hospitals in North Rhine–Westphalia

Englbrecht, Jan Sönke; Schrader, Daniel; Kraus, Holger; Schäfer, Melanie; Schedler, Dirk; Bach, Friedhelm; Söhle, Martin

doi:10.3238/arztebl.m2022.0367

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…Predominant reasons for a donation not being utilized in the deceased were refused consent and the impossibility to diagnose BD because of preserved brain stem reflexes. These results are in line with previous findings in Germany and elsewhere about reasons for a donation not utilized 18 , 32 , 35 – 37 .…”

Section: Discussionsupporting

confidence: 93%

A ten-year retrospective analysis of decompressive craniectomy or craniotomy after severe brain injury and its implications for donation after brain death

Englbrecht,

Bajohr,

Zarbock

et al. 2024

Sci Rep

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Craniotomy or decompressive craniectomy are among the therapeutic options to prevent or treat secondary damage after severe brain injury. The choice of procedure depends, among other things, on the type and severity of the initial injury. It remains controversial whether both procedures influence the neurological outcome differently. Thus, estimating the risk of brain herniation and death and consequently potential organ donation remains difficult. All patients at the University Hospital Münster for whom an isolated craniotomy or decompressive craniectomy was performed as a treatment after severe brain injury between 2013 and 2022 were retrospectively included. Proportion of survivors and deceased were evaluated. Deceased were further analyzed regarding anticoagulants, comorbidities, type of brain injury, potential and utilized donation after brain death. 595 patients were identified, 296 patients survived, and 299 deceased. Proportion of decompressive craniectomy was higher than craniotomy in survivors (89% vs. 11%, p < 0.001). Brain death was diagnosed in 12 deceased and 10 donations were utilized. Utilized donations were comparable after both procedures (5% vs. 2%, p = 0.194). Preserved brain stem reflexes as a reason against donation did not differ between decompressive craniectomy or craniotomy (32% vs. 29%, p = 0.470). Patients with severe brain injury were more likely to survive after decompressive craniectomy than craniotomy. Among the deceased, potential and utilized donations did not differ between both procedures. This suggests that brain death can occur independent of the previous neurosurgical procedure and that organ donation should always be considered in end-of-life decisions for patients with a fatal prognosis.

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Section: Discussionsupporting

confidence: 93%

A ten-year retrospective analysis of decompressive craniectomy or craniotomy after severe brain injury and its implications for donation after brain death

Englbrecht,

Bajohr,

Zarbock

et al. 2024

Sci Rep

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“…Consent to donation was reduced during the first wave of the pandemic in some countries ( 13 ), probably due to uncertainty and reduced possibilities to discuss a donation with family members ( 9 , 12 ). Reliable data for consent rates in Germany during the pandemic are lacking ( 40 ), but traditionally, refused consent is a relevant reason against donation in Germany ( 22 , 46 ). In this cohort, refused consent was higher in 2021 than 2022.…”

Section: Discussionmentioning

confidence: 99%

Post-COVID-19 pandemic organ donation activities in Germany: a multicenter retrospective analysis

Englbrecht,

Schrader,

Alders

et al. 2024

Front. Public Health

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IntroductionThe COVID-19 pandemic had a negative impact on the number of solid organ transplantations. After a global decline of 16% in 2020, their numbers subsequently returned to pre-pandemic levels. In contrast, numbers in Germany remained almost constant in 2020 and 2021 but fell by 6.9% in 2022. The reasons for this divergent development are unknown.MethodsThe number of deceased with a severe brain damage, potential and utilized donors after braindeath and the intensive care unit treatment capacity were retrospectively compared for the years 2022 and 2021 at five university hospitals in North Rhine-Westphalia, Germany. Reasons for a donation not utilized were reviewed. To enable a comparison of the results with the whole of Germany and the pre-pandemic period, numbers of potential and utilized donors were extracted from official organ donation activity reports of all harvesting hospitals in Germany for the years 2019–2022.ResultsThe numbers of deceased with a severe brain damage (−10%), potential (−9%), and utilized donors after braindeath (−44%), and intensive care unit treatment capacities (−7.2%) were significantly lower in 2022 than 2021. A COVID-19 infection was a rarer (−79%), but donor instability (+44%) a more frequent reason against donation in 2022, whereas preserved brain stem reflexes remained the most frequent reason in both years (54%). Overall numbers of potential and utilized donations in Germany were lower in 2022 than in the pre-pandemic period, but this was mainly due to lower numbers in hospitals of lower care. The number of potential donors in all university hospitals were higher in 2022 but utilized donations still lower than in 2019.ConclusionThe decrease in potential and utilized donations was a result of reduced intensive care unit treatment capacities and a lower conversion rate at the five university hospitals. A COVID-19 infection did not play a role in 2022. These results indicate that ICU treatment capacities must be restored to increase donations. The lower number of potential donors and the even lower conversion rate in 2022 throughout Germany show that restructuring the organ procurement process in Germany needs to be discussed to increase the number of donations.

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“…Published preliminary data from our workgroup revealed, that consent is significantly dependent on whether and how the potential DBD has documented his will to donate. Highest consent rate is found when a will to donate is previously confirmed in writing by the potential DBD whereas it is lowest for a decision by family members if the will of the donor is unknown [ 14 ]. The present analysis intents to provide further answers on the question of how many potential DBD exist in the participating hospitals, how many donations can be utilized, and what factors influence consent and utilization of organ donation after brain death.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, we thank Dr. Leonie Weinhold, Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, for statistical advice. Preliminary data of this work were previously published as a research letter in the “Deutsches Ärzteblatt International” [ 14 ].…”

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confidence: 99%

How Large is the Potential of Brain Dead Donors and what Prevents Utilization? A Multicenter Retrospective Analysis at Seven University Hospitals in North Rhine-Westphalia

et al. 2023

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Organ donation after brain death is constantly lower in Germany compared to other countries. Instead, representative surveys show a positive attitude towards donation. Why this does not translate into more donations remains questionable. We retrospectively analyzed all potential brain dead donors treated in the university hospitals of Aachen, Bielefeld, Bonn, Essen, Düsseldorf, Cologne and Münster between June 2020 and July 2021. 300 potential brain dead donors were identified. Donation was utilized in 69 cases (23%). Refused consent (n = 190), and failed utilization despite consent (n = 41) were reasons for a donation not realized. Consent was significantly higher in potential donors with a known attitude towards donation (n = 94) compared to a decision by family members (n = 195) (49% vs. 33%, p = 0.012). The potential donor´s age, status of interviewer, and the timing of the interview with decision-makers had no influence on consent rates, and it was comparable between hospitals. Refused consent was the predominant reason for a donation not utilized. Consent rate was lower than in surveys, only a known attitude towards donation had a significant positive influence. This indicates that survey results do not translate well into everyday clinical practice and promoting a previously documented decision on organ donation is important.

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Advance directives and consent to organ donation in seven university hospitals in North Rhine–Westphalia

Cited by 4 publications

References 3 publications

A ten-year retrospective analysis of decompressive craniectomy or craniotomy after severe brain injury and its implications for donation after brain death

A ten-year retrospective analysis of decompressive craniectomy or craniotomy after severe brain injury and its implications for donation after brain death

Post-COVID-19 pandemic organ donation activities in Germany: a multicenter retrospective analysis

How Large is the Potential of Brain Dead Donors and what Prevents Utilization? A Multicenter Retrospective Analysis at Seven University Hospitals in North Rhine-Westphalia

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