Intensive care practices in brain death diagnosis and organ donation

Abstract

Summary We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4–5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life‐sustaining measures were withdrawn in 413/553 of non‐donors (75%).

Brain death diagnosis in adult for potential cadaveric organ donation in Bangladesh

“…In our study the length of ICU stay was < 48 hours in 47% of cases after brain death diagnosis whereas in a study done by Escudero D et al 28 , 50% of cases had length of stay was ≤ 24 hours.…”

“…Length of ICU stay depended on severity (GCS) at admission: as severity increased, the length of stay decreased. In the study done by Escudero 28 showed GCS was ≤ 8/15 in 91% of the patients admitted and patients deteriorated to brain death (50% in the first 24 h).…”

“…In a study done by Escudero D et al 28 , the diagnosis of brain death was done exclusively on clinical examination in only 92 patients (5%), while at least one ancillary test was used in 1752 patients (95%). Diagnosis of brain death was based on the clinical examination as well as apnea test in all cases in our study.…”

“…In a study done by Escudero total 1291(70%) of the 1844 brain death patients became actual organ donors 28 .…”

Untitled

“…In a recent Spanish study, 56% of brain death was by CVA and 19% was by traumatic brain injury. 22 In our study, 5% of kidneys were discarded after they were retrieved. Klein and associates reported that the discard rate after recovery increased from 12% in 1999 to 16% in 2008.…”