Variability in Diagnosing Brain Death at an Academic Medical Center

Pandey, Ashutosh; Sahota, Pradeep; Nattanmai, Premkumar; Newey, Christopher R.

doi:10.1155/2017/6017958

Cited by 20 publications

(19 citation statements)

References 23 publications

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“…Intracerebral hemorrhage was the most common cause of brain death in our study, similar to the studies by Escudero et al [13] and Pandey et al [3]. However, many studies reported different primary causes of brain death [14-15,19].…”

Section: Discussionsupporting

confidence: 90%

“…In our hospital, 44.5% of brain death cases became donors between 2011 and 2016. Most of the patients diagnosed with brain death were male, similar to other studies [3,13-16]. Trauma is more common in males in some studies in our country, but there is no information about gender in the Turkish Statistical Institute data.…”

Section: Discussionsupporting

confidence: 86%

“…The brain death determination method differs in each country throughout the world [2-3,13] In our hospital, the clinical determination rate was only 22.6%, whereas the clinical determination and ancillary test confirmation rate was 77.4%. Since there was no contraindication of transportation, we chose to perform an ancillary test to determine brain death in many cases to reduce the observation time.…”

Section: Discussionmentioning

confidence: 99%

“…Brain death determination criteria were first published in 1968, a year after the first heart transplantation. Attitudes toward brain death differ greatly between countries worldwide, and there is no global consensus in diagnostic criteria [2-3]. The American Academy of Neurology published guidelines and practice parameters to help physicians determine brain death.…”

Section: Introductionmentioning

confidence: 99%

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Brain Death and Organ Donation Rates in a City Hospital: A Retrospective Study

Ferhatoğlu

Yapıcı

2019

Cureus

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Introduction Although organ donation rates have been increasing over the years, the lack of organ donation remains the most important problem in transplantation. By changing strategies, the Cekirge City Hospital in Bursa/Osmangazi has achieved a cadaveric donor rate of 24.9 per one million individuals in 2016; this rate is 21.5 in England, 20.9 in Norway, 14.7 in the Netherlands, and 10.6 in Germany. Methods Brain death cases were retrospectively evaluated between January 1, 2011, and December 31, 2016. Results There were a total of 137 brain death cases. Three of eight cases, five of 12 cases, three of 13 cases, 13 of 25 cases, 16 of 29 cases, and 21 of 50 cases became a donor in 2011, 2012, 2013, 2014, 2015, and 2016, respectively. Conclusion Deceased organ donation rates have increased over the years; however, the number of brain dead patients and the acceptance of organ donation by families have been increasing, but the percentage of brain death donations did not increase. We suggest that the reason for this situation is that well-trained and educated physicians diagnose more brain death cases and have a greater desire to treat end-stage organ failure patients, but the tendency of the public to donate has not increased as hoped. Donation and transplantation rates may be increased with a combination of well-trained, educated, and dedicated physicians with public education.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Brain Death and Organ Donation Rates in a City Hospital: A Retrospective Study

Ferhatoğlu

Yapıcı

2019

Cureus

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“…In Turkey two clinicians with specific departments are required to diagnose BD. There is a huge variability of knowledge and practices for BD declaration among physicians despite there are clear algorithms for the diagnosis (11)(12)(13). It was reported that asynchrony between physicians may cause problems not only in the diagnosis of BD but also organ donation.…”

Section: (42)mentioning

confidence: 99%

Current Status of Organ Donation in a University Hospital in İzmir: Identifying Obstacles and Possible Future Solutions

Aydin¹,

Ergan²,

Tokur³

et al. 2019

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Objective: Although many new interventions including changes in diagnostic policies are performed to increase the rates of diagnosis of brain death (BD) and organ donation in recent years in Turkey, data about the longitudinal effects are limited. The aim of this study was to understand the current status of organ donation in İzmir and to find out whether new regulations have any effect on the diagnosis of BD and organ donation rates. Materials and Methods: All patients diagnosed with BD between January 2001 and December 2016 in a tertiary university hospital were included, and patient data and organ donation status were collected from medical records. Results: There were 303 patients diagnosed with BD during the study period. The most common reason in the pediatric group (n=42) was traumatic brain injury (42.9%) and 12 of these patients (28.6%) became organ donors. In the adult patient group (n=261), the most common reason was intracranial hemorrhage (39.8%) and 97 patients (37.2%) became organ donors. The rate of BD diagnosis increased over the years (from 0.59% to 0.67% after legal regulation), but there was no increase in organ donation rate (39.5 vs 26.5%). The most common cause of ineligibility for donation was refusal by patient's relatives in both pediatric and adult patients (83.3% and 86.6% respectively). Conclusion: This study shows that although the diagnosis of BD has increased over the years, organ donation rates are still low in İzmir. New strategies aiming to increase awareness and change the perception of organ donation should be planned as soon as possible.ÖZ Amaç: Türkiye'de son yıllarda beyin ölümü teşhisi ve organ bağışını arttırmak amacıyla teşhis yöntemlerindeki değişiklikleri de kapsayan pek çok yeni uygulama yapılmasına rağmen bunların etkileri ile ilgili bilgilerimiz sınırlıdır. Bu çalışmanın amacı İzmir'de organ bağışının mevcut durumunu anlamak ve yeni düzenlemelerin beyin ölümü teşhisi ve organ bağışı üzerinde herhangi bir etkisi olup olmadığını öğrenmektir. Gereç ve Yöntem: Bir üçüncü basamak üniversite hastanesinde Ocak 2001 ve Aralık 2016 arasındaki beyin ölümü teşhisi konan tüm hastalar, hasta verileri, organ nakli durumu tıbbi kayıtlardan elde edildi. Bulgular: Çalışma süresince beyin ölümü teşhisi konan 303 hasta mevcuttu. Pediatrik grupta (n=42) en çok görülen teşhis travmatik beyin hasarıydı (%42,9). Bu hastalardan 12 hasta (%28,6) donör oldu. Yetişkin hasta grubunda (n=261) en sık görülen teşhis intrakraniyal kanamaydı (%39,8) ve 97 hasta (%37,2) donör olmuştu. beyin ölümü teşhis hızı yıllar içerisinde artmıştı (yasal düzenlemeden sonra %0,59'dan %0,67'ye yükselmişti), ancak organ nakil hızında artış yoktu (düzenlemeden önce %39,5, düzenlemeden sonra %26,5). Organ nakli yapılamamasının en sık görülen sebebi hem pediatrik, hem de yetişkin hasta grubunda hasta yakını reddiydi (pediatrik %83,3, yetişkin %86,6). Sonuç: Çalışma İzmir'de beyin ölümü teşhisinin yıllar içerisinde artmasına rağmen organ naklinin hala düşük kaldığını göstermektedir. Farkındalığı arttıracak ve organ nak...

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Determination of Brain Death/Death by Neurologic Criteria

Greer

Shemie

Lewis

et al. 2020

JAMA

452

533

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ImportanceThere are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries.ObjectiveTo formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel.ProcessRelevant international professional societies were recruited to develop recommendations regarding determination of BD/DNC. Literature searches of the Cochrane, Embase, and MEDLINE databases included January 1, 1992, through April 2020 identified pertinent articles for review. Because of the lack of high-quality data from randomized clinical trials or large observational studies, recommendations were formulated based on consensus of contributors and medical societies that represented relevant disciplines, including critical care, neurology, and neurosurgery.Evidence SynthesisBased on review of the literature and consensus from a large multidisciplinary, international panel, minimum clinical criteria needed to determine BD/DNC in various circumstances were developed.RecommendationsPrior to evaluating a patient for BD/DNC, the patient should have an established neurologic diagnosis that can lead to the complete and irreversible loss of all brain function, and conditions that may confound the clinical examination and diseases that may mimic BD/DNC should be excluded. Determination of BD/DNC can be done with a clinical examination that demonstrates coma, brainstem areflexia, and apnea. This is seen when (1) there is no evidence of arousal or awareness to maximal external stimulation, including noxious visual, auditory, and tactile stimulation; (2) pupils are fixed in a midsize or dilated position and are nonreactive to light; (3) corneal, oculocephalic, and oculovestibular reflexes are absent; (4) there is no facial movement to noxious stimulation; (5) the gag reflex is absent to bilateral posterior pharyngeal stimulation; (6) the cough reflex is absent to deep tracheal suctioning; (7) there is no brain-mediated motor response to noxious stimulation of the limbs; and (8) spontaneous respirations are not observed when apnea test targets reach pH <7.30 and Paco2 ≥60 mm Hg. If the clinical examination cannot be completed, ancillary testing may be considered with blood flow studies or electrophysiologic testing. Special consideration is needed for children, for persons receiving extracorporeal membrane oxygenation, and for those receiving therapeutic hypothermia, as well as for factors such as religious, societal, and cultural perspectives; legal requirements; and resource availability.Conclusions and RelevanceThis report provides recommendations for the minimum clinical standards for determination of brain death/death by neurologic criteria in adults and children with clear guidance for various clinical circumstances. The recommendations have widespread international society endorsement and can serve to guide professional societies and countries in...

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Variability in Diagnosing Brain Death at an Academic Medical Center

Cited by 20 publications

References 23 publications

Brain Death and Organ Donation Rates in a City Hospital: A Retrospective Study

Brain Death and Organ Donation Rates in a City Hospital: A Retrospective Study

Current Status of Organ Donation in a University Hospital in İzmir: Identifying Obstacles and Possible Future Solutions

Determination of Brain Death/Death by Neurologic Criteria

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