Time trends in organ donation after neurologic determination of death: a cohort study

Abstract

Background:The cause of brain injury may influence the number of organs that can be procured and transplanted with donation following neurologic determination of death. We investigated whether the distribution of causes responsible for neurologic death has changed over time and, if so, whether this has had an impact on organ quality, transplantation rates and recipient outcomes. Methods:We performed a cohort study involving consecutive brain-dead organ donors in southern Alberta between 2003 and 2014. For each donor, we determined last available measures of organ injury and number of organs transplanted, and compared these variables for various causes of neurologic death. We compared trends to national Canadian data for 2000-2013 (2000-2011 for Quebec).Results: There were 226 brain-dead organ donors over the study period, of whom 100 (44.2%) had anoxic brain injury, 63 (27.9%) had stroke, and 51 (22.6%) had traumatic brain injury. The relative proportion of donors with traumatic brain injury decreased over time (> 30% in 2003-2005 v. 6%-23% in 2012-2014) (p = 0.004), whereas that with anoxic brain injury increased (14%-37% v. 46%-80%, respectively) (p < 0.001). Nationally, the annual number of brain-dead donors with traumatic brain injury decreased from 4.4 to less than 3 per million population between 2000 and 2013, and that with anoxic brain injury increased from 1.1 to 3.1 per million. Donors with anoxic brain injury had higher concentrations of creatinine, alanine aminotransferase and troponin T, and lower P a O 2 /F I O 2 and urine output than donors with other diagnoses. The average number of organs transplanted per donor was 3.6 with anoxic brain injury versus 4.5 with traumatic brain injury or stroke (p = 0.002).Interpretation: Anoxic brain injury has become a leading cause of organ donation after neurologic determination of death in Canada. Organs from donors with anoxic brain injury have a greater degree of injury, and fewer are transplanted. These findings have implications for availability of organs for transplantation in patients with end-stage organ failure. AbstractResearch Research CMAJ OPEN E20CMAJ OPEN, 5(1)We performed a cohort study among consecutive braindead donors in southern Alberta to determine whether the distribution of causes responsible for neurologic death has changed (primary outcome) and, if so, whether this has had an impact on organ quality, transplantation rates and recipient outcomes (secondary outcomes). Using data from the Canadian Institute of Health Information (CIHI), we also assessed trends in the cause of neurologic death and number of organs transplanted per donor across Canada. Methods SettingA comprehensive clinical information system (ALTRABase) is used to manage all organ donation referrals in southern Alberta and enables linkage of donor and recipient data. Donor management is in accordance with national guidelines, which are incorporated directly into a region-wide electronic order set. 18 In every case, solid organs are routinely offered to transplantation ...

Donation after circulatory determination of death in western Canada: a multicentre study of donor characteristics and critical care practices

“…Most donors die from the same conditions that lead to NDD, most often HIBI, followed by traumatic brain injury and various forms of stroke. 20 When consent is obtained for DCD, it is important to consider and identify the possibility of subsequent progression to NDD, since a larger number of organs can be procured per donor. A high rate of donors with a history of drug abuse likely reflects the recent opiate crisis, which has affected British Columbia more than other Canadian provinces.…”

Hemodynamic management in brain dead donors

“…Diastolic blood pressure is known to increase up to the age of about 50 years due to the rise in arteriolar resistance, but, later in life, the large artery stiffening contributes a wider pulse pressure including a decreased diastolic blood pressure. In the BD donor, this phenomenon may affect perfusion pressure, highlighting potential difficulties in hemodynamic management in older donors, and it may be worsened by the age-related reduction in β-receptor function[ 77 ]. In 92 consecutive DBDs[ 78 ], advancing age was associated with a more pronounced vasodilatation (lower values of diastolic blood pressure) probably due to age-related reduction in arterial stiffness and beta-receptor function (conditioning a reduced response to endogenous and/or exogenous norepinephrine stimulation).…”

Trends in deceased organ donation in Canada

“…Before southern Alberta implemented DCD and because at the time it did not have a donation physician program, the region had witnessed a decrease in the incidence in brain death. 11 Ontario has seen an increase in both DCD and donation following brain death and temporally in association with implementing donation physicians. 12 This suggests that implementation of a DCD program in association with intensive care unit physicians who are focused on donation therefore drives the improvement of all forms of deceased organ donation.…”