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

Excerpt

The brain dead patient is the ideal multiorgan donor. However, brain death is an undesirable outcome of neurocritical care and an artefact of nature resulting from the ability of medical technology to distort the dying process. One of the goals of neurocritical care is preventing brain death from occurring. Conditions leading to brain death are limited with subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), and intracerebral hemorrhage (ICH) preceding brain death in over 80 % of the cases. Progress in prevention and treatment of these conditions has resulted in a sharp decline in the number of brain dead patients [1, 2]. For example, in the Netherlands, the number of donations after brain death declined by 30 % in the period 1995–2009 [3]. However, in the same period, donation after circulatory death increased by 282 %. This has great ramifications for the availability of all organs, but especially for hearts, which, respecting the principle of the ‘dead donor rule’, can only be obtained from brain dead donors. As this decline is inescapable and desirable, seen from the perspectives of patients and society, the transplant community should anticipate this process by searching for alternatives and for better recognition and use of possible organ donors. Several initiatives have been undertaken to improve organ donation, such as the initiation of presumed consent legislation, improved attention to the request procedures, and improved awareness of ICU-physicians and ICU-nurses in the recognition and identification of possible organ donors. …