Imprecise definitions of starting points in retrospectively reviewing potential organ donors causes confusion: call for a reproducible method like ‘imminent brain death’

Abstract

Summary Low donor supply and the high demand for transplantable organs is an international problem. The efficiency of organ procurement is often expressed by donor conversion rates (DCRs). These rates differ among countries, but a uniform starting point for defining a potential heart‐beating donor is lacking. Imprecise definitions cause confusion; therefore, we call for a reproducible method like imminent brain death (IBD), which contains criteria in detail to determine potential heart‐beating donors. Medical charts of 4814 patients who died on an ICU in Dutch university hospitals between January 2007 and December 2009 were reviewed for potential heart‐beating donors. We compared two starting points: ‘Severe Brain Damage’ (SBD) (old definition) and IBD (new definition), which differ in the number of absent brainstem reflexes. Of the potential donors defined by IBD 45.6% fulfilled the formal brain death criteria, compared with 33.6% in the larger SBD group. This results in a higher DCR in the IBD group (40% vs. 29.5%). We illustrated important differences in DCRs when using two different definitions, even within one country. To allow comparison among countries and hospitals, one universal definition of a potential heart‐beating donor should be used. Therefore, we propose the use of IBD.

Prediction of evolution toward brain death upon admission to ICU in comatose patients with spontaneous intracerebral hemorrhage using simple signs

“…Some experts have recently proposed definitions of imminent BD based on abolished brain stem responses [17,18]. Recently, analyzing patients who died on an ICU in Dutch university hospitals, it has been reported that 45.6% of patients with imminent BD actually evolved toward BD [19]. The aim of this study was not to identify predictors of evolution toward BD as early as possible.…”

“…The aim of this study was not to identify predictors of evolution toward BD as early as possible. It has to be noticed that the accuracy of this imminent BD definition has not been evaluated upon the admission to ICU, but at any moment during the ICU stay [19]. Moreover, using our simple three-group classification of BD risk upon the admission to ICU based on the corneal reflexes abolition and the swirl sign, 83% of patients with high risk of BD and 50% of patients with intermediate risk of BD actually evolved toward BD.…”

“…However, other patients who died as result of BD, but did not become organ donors were not reported. Recently, analyzing patients who died in ICU in Dutch university hospitals, it has been reported that 45.6% of patients with "imminent BD" actually evolved toward BD [19]. However, "imminent BD" definitions were not evaluated upon admission to the ICU.…”

Intensive care practices in brain death diagnosis and organ donation

“…Jansen et al. reviewed 4814 deaths in ICUs of university hospitals in the Netherlands . Of the imminent brain death cases, 45.6% ultimately fulfilled formal brain death criteria, compared with 33.6% in the larger group categorised as having severe brain injury.…”

‘In plain language’: uniform criteria for organ donor recognition

“…It is essential that all researchers use the same definition for potential organ donor recognition. Without this, comparison between countries and hospitals is impossible [7]. That the OPTN definition, which does not use the coma status of the patient, is not a very practical one is proved by the results by Kutsogiannis and colleagues that, out of the 114 patients with at least three absent brainstem reflexes, 74 had this irrespective of the GCS and 64 met the criteria of a GCS score of 3.…”