Retrospective Analysis of 1998 Patients Diagnosed with Brain Death between 2011 and 2019 in Turkey

Abstract

Background Organ transplantation reduces mortality and morbidity in patients with end-stage organ failure. The number of living organ donations is not enough to meet the current organ transplantation need; therefore, there is an urgent need for organ donation from cadavers. We aimed to determine the organ donation rates and reveal the obstacles against donation. Methods This study is designed as a retrospective multicenter study consisting of eight university hospitals, three training and research hospitals, 26 state hospitals, and 74 private hospitals in nine provinces in Turkey. A total of 1,998 patients diagnosed with brain death between January 2011 to April 2019 were examined through the electronic medical records data system. Results Median patient age was 38 (IQR: 19–57), and 1,275 (63.8%) patients were male. The median time between the intensive care unit admission and brain death diagnosis was 56 (IQR:2–131) hours. The most commonly used confirmatory diagnostic test was computed tomography in 216 (30.8%) patients, and the most common cause of brain death was intraparenchymal hemorrhage with 617 (30.9%) patients. A total of 1,646 (82.4%) families refused to permit organ donation. The most common reasons for refusal were family disagreement (68%), social/relative pressure (24%), and religious beliefs (8%). Conclusions Many families refuse permission for organ donation; some of the provinces included in this study experienced years of exceptionally high refusal rates.

Retrospective Analysis of Patients Diagnosed with Brain Death in Our Hospital in the Last 15 Years

“…In two separate studies conducted in Türkiye between 2008–2019 and 2014–2018, it was determined that approximately 55% of the cases were male and the mean age was 49 and 53, respectively. [ 8 , 9 ] In addition, in the study of Sipahioglu et al [ 10 ] examining the cases diagnosed with 1998 brain death between 2011 and 2019, 63.8% were male and 36.2% were female, and the median age of the cases was 38 years. In the cohort study conducted on 69,735 cases in the USA between 2012 and 2016, 56.47% of the cases were male and 43.53% were female.…”

“…The primary disease causing permanent brain death in Türkiye has been identified as approximately 50–55% intracranial haemorrhage. [ 8 , 10 , 15 ] In Spain with 1844 cases and in Italy with 1286 cases, the primary disease causing death was found to be intracranial hemorrhage in 56% and 52%, respectively. [ 16 , 17 ] In the study literature, the primary disease of cases with brain death was found to be hemorrhagic cerebral damage in 47% of cases.…”

“…In studies conducted in Türkiye, the mean time between admission to intensive care unit and diagnosis of brain death was found to be 2.5–6 days. [ 9 , 10 , 15 , 23 ] In a study conducted in Europe, it was found between 2.5 and 7 days. [ 17 ] In our study, the mean time between admission to the intensive care unit and the diagnosis of brain death was found to be 6 days, consistent with the literature.…”

“…[ 24 ] In studies where confirmatory testing was used in diagnosing brain death in Türkiye, it was used in 30–70% of patients, and we see that CT angio was used most frequently. [ 8 , 10 , 15 ] Ancillary tests were used at a rate of 24% in Sweden and 95% in Spain. CT angio and EEG were used most frequently, [ 12 , 16 ] respectively.…”