Top

Intensive Care Medicine

Published in:

01-02-2006 | Original

Organ donations and unused potential donations in traumatic brain injury, subarachnoid haemorrhage and intracerebral haemorrhage

Authors: Erwin J. O. Kompanje, Jan Bakker, François J. A. Slieker, Jan N. M. IJzermans, Andrew I. R. Maas

Published in: Intensive Care Medicine | Issue 2/2006

Abstract

Objective

To obtain insight into the occurrence of brain death and the potential for brain dead and controlled non-heart-beating organ donors (CNHB) in patients with traumatic brain injury (TBI), subarachnoid haemorrhage (SAH) and intracerebral haemorrhage (ICH) in a large neurosurgical serving area (2.1 million inhabitants).

Design

Retrospective analysis of data concerning patients with TBI, SAH and ICH who died during the course of ICU treatment during 1999–2003.

Setting

A 16-bed neuro-intensive care unit.

Patients

Patients with TBI, SAH or ICH who died during the course of ICU treatment.

Measurements and results

The number of ICU deaths in patients with TBI, SAH and ICH declined from 111 in 1999 to 64 in 2003. In total, 476 deaths occurred. Of these, 177 patients were not included in the analysis. Two hundred ninety-nine (299) ventilated patients had two or more absent brainstem reflexes (ABSR) and a Glasgow Coma Score of 3–4 at the moment of treatment withdrawal and formed the potential for organ donation; 61 of these patients were treated until full brain death. Organs of 57 patients could be harvested. We analysed the reasons that organs were not procured in the 242 remaining patients. The most important reasons were family refusal (32%), medical contraindications (14%), and the treating physician not considering potential organ donation (20%). The missed potential is 162/299 (54%).

Conclusions

The number of actual and potential organ donors is declining, but a considerable number of potential CNHB donors exists. Refusal by relatives is the most important reason for failure to procure organs.

Pugliese MR, Esposti DD, Dormi A, Venturoli N, Gaito PM, Buscaroli A, Petropulacos K, Costa AN, Ridolfi L (2003) Improving donor identification with the donor action programme. Trans Int 16:21–25CrossRef

Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, Ledoux D, Lippert A, Maia P, Phelan D, Schobersberger W, Wennberg E, Woodcock T (2004) End-of-life practices in European intensive care units. JAMA 290:790–797CrossRef

Navarro A (1996) Brain death epidemiology; the Madrid study. Transplant Proc 28:103–104PubMed

Salih MAM, Harvey I, Frankel S, Coupe DJ, Webb M, Cripps HA (1991) Potential availability of cadaver organs for transplantation. BMJ 302:1053–1055PubMed

Chiara O, Scott JD, Cimbanassi S, Marini A, Zoia R, Rodriguez A, Scalea T, Colombo F, Freni L, Padalino P, Segala M, Tiberio G, Giovanola M, Pellegrinelli M, Macrì L, Omboni E, Iapichino G, Baticci F, Cerchiari E, Guffanti E, Pugliese R, Sesana G, Martinetti R, Ronchi E, Staudacher C, Carlucci M, Sotttili S, Trevano GQ (2002) Trauma deaths in an Italian urban area: an audit of pre-hospital and in-hospital trauma care. Injury 33:553–562PubMedCrossRef

Senouci K, Guerrini P, Diene E, Atinault A, Claquin J, Bonnet F, Tuppin P (2004) A survey on patients admitted in severe coma: implications for brain death identification and organ donation. Intensive Care Med 30:38–44CrossRefPubMed

Altinörs N, Benli S, Caner H, Altaş A, Bavbek M, Bilgin N (1998) Brain dead donors for organ transplantation. Transplant Proc 30:771–772PubMedCrossRef

Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ (2002) Specialist neurocritical care and outcome from head injury. Intensive Care Med 28:547–553CrossRefPubMed

Broderick JP, Brott TG, Duldner JE, Tomsick T, Leach A (1994) Initial and recurrent bleeding are the major causes of death following subarachnoid haemorrhage. Stroke 25:1342–1347PubMed

10.

Dominguez-Roldan JM, Garcia-Alfaro C, Diaz-Parejo P, Barrera-Chacon JM, Caldera-Gonzalez A, Murillo-Cabezas F (2002) Identification of subarachnoid hemorrhages with high risk of evolution to brain death. Transplant Proc 34:9–10PubMedCrossRef

11.

Dşemeci L, Yilmaz M, Cengiz M, Dora B, Ramazanoðlu A (2004) Brain death and donor management in the intensive care unit: experiences over the last 3 years. Transplant Proc 36:20–21CrossRefPubMed

12.

Pratschke J, Paz D, Wilhelm MJ, Laskowski I, Kofla G, Vergopoulos A, MacKenzie HJ, Tullius S, Neuhaus P, Hancock WW, Volk HD, Tilney NL (2004) Donor hypertension increases graft immunogenicity and increases chronic changes in long-standing renal allografts. Transplantation 77:43–48CrossRefPubMed

13.

Morris PJ, Johnsonm RJ, Fuggle SV, Belger MA, Briggs JD (1999) Analysis of factors that affect outcome of primary cadaveric renal transplantation in the UK. Lancet 354:1147–1152PubMedCrossRef

14.

Tullius SG, Volk HD, Neuhaus P (2001) Transplantation of organs from marginal donors. Transplantation 72:1341–1349PubMedCrossRef

15.

Dominguez-Roldan JM, Barrera-Chacon JM, Martin-Bermudez R, Santamaria-Milsut JL, Flores-Cordero JM, Gonzalez PJ (1999) High-risk spontaneous cerebral hematomas leading to brain death: early detection of potential organ donors. Transplant Proc 31:2595–2596PubMedCrossRef

16.

Schaeffer MJ, Johnson E, Suddaby EC, Suddaby SC, Brigman LE (1998) Analysis of donor versus nondonor demographics. J Transpl Coord 8:9–15PubMed

17.

Siminoff LA, Gordon N, Hewlett J, Arnold RM (2001) Factors influencing families consent for donation of solid organs for transplantation. JAMA 286:71–77CrossRefPubMed

18.

Matesanz R, Miranda B (2002) A decade of continuous improvement in cadaveric organ donation: The Spanish model. J Nephrol 15:22–22PubMed

19.

Procaccio F, Barbacini S, Meroni M, Sarpellon M, Verlato R, Giron GP (2001) Deaths with acute cerebral lesion and heart-beating potential organ donors in the Veneto Region. Minerva Anestesiol 67:71–78PubMed

20.

Opdam HI, Silvester W (2004) Identifying the potential organ donor: an audit of hospital deaths. Intensive Care Med 20:1390–1397

21.

Kleindienst A, Haupt WF, Hildebrandt G (1999) Brain death and organ donation in Germany: analysis of procurement in a neurosurgical unit and review of press reports. Acta Neurochir (Wien) 141:641–646CrossRef

22.

Faltin DL, Jeannet M, Suter PM (1992) The decrease in organ donations from 1985 to 1990 caused by increasing medical contraindications and refusals by relatives. Transplantation 54:85–88PubMedCrossRef

23.

Gore SM, Hinds CJ, Rutherford AJ (1989) Organ donation from intensive care units in England. BMJ 299:1193–1197PubMedCrossRef

24.

Sheehy E, Conrad SL, Brigham LE, Luskin R, Weber P, Eakin M, Schkade L, Hunsicker L (2003) Estimating the number of potential organ donors in the United States. N Engl J Med 349:667–674CrossRefPubMed

25.

Cohen B, Smits JM, Haase B, Persijn G, Vanrenterghem Y, Frei U (2005) Expanding the donor pool to increase renal transplantation. Nephrol Dial Transplan 20:34–41CrossRef

Title: Organ donations and unused potential donations in traumatic brain injury, subarachnoid haemorrhage and intracerebral haemorrhage
Authors: Erwin J. O. Kompanje
Jan Bakker
François J. A. Slieker
Jan N. M. IJzermans
Andrew I. R. Maas
Publication date: 01-02-2006
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 2/2006
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-005-0001-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Organ donations and unused potential donations in traumatic brain injury, subarachnoid haemorrhage and intracerebral haemorrhage

Abstract

Objective

Design

Setting

Patients

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Measurements and results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2006

Muscle force and fatigue in patients with sepsis and multiorgan failure

Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients

Is lung ultrasound superior to CT? The example of a CT occult necrotizing pneumonia

Protected telescopic catheter also allows anaerobic bacteria isolation in patients with ventilatory-acquired pneumonia

Transcutaneous arterial carbon dioxide pressure monitoring in critically ill adult patients

Oral Care Reduces Incidence of Ventilator-Associated Pneumonia in ICU Populations