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Brain death and donor management in the intensive care unit: experiences over the last 3 years
L Döşemeci1, M Yilmaz, M Cengiz
1Department of Anesthesiology and Intensive Care, Akdeniz University Hospital, Antalya, Turkey. leventege@yahoo.com
Insights
This study tracked brain death, organ donation rates, and donor management challenges in an ICU from 2000-2003. Despite issues, a high organ donor ratio was achieved, exceeding national averages.
Area of Science:
- Intensive Care Medicine
- Neurosurgery
- Transplantation Medicine
Background:
- Brain death diagnosis and management are critical in ICUs.
- Organ donation rates vary significantly and impact transplantation availability.
- Effective donor management is essential to preserve organ viability.
Purpose of the Study:
- To determine the incidence of brain death in an ICU setting.
- To evaluate organ donation rates among brain-dead patients.
- To identify challenges in donor management and their impact.
Main Methods:
- Prospective study of 134 brain-dead patients over 3 years (2000-2003).
- Analysis of patient demographics, cause of brain death, and time to diagnosis.
- Monitoring of physiological parameters and complications during donor management.
Main Results:
- Out of 940 patients with cerebral injuries, 134 were diagnosed with brain death.
- Fifty-three percent of eligible brain-dead patients became organ donors.
- The donor ratio was 12 per million population, significantly higher than the Turkish average.
Conclusions:
- The ICU achieved a high organ donation rate despite challenges in donor management.
- Effective management protocols can overcome life-threatening complications during organ donation.
- This study highlights the potential for increasing organ donor numbers through dedicated care.
Abstract:
We sought to examine the frequency of brain death in the ICU, the donation rate, and the problems encountered during donor management between the years of January 2000, the date we began treating patients with neurologic pathologies and traumatic brain injury, and March 2003. Between January 2000 and March 2003, 134 patients diagnosed with brain death in our ICU were studied prospectively for the reason of brain death, the time between admission to ICU, and the diagnosis of brain death, the frequency of diabetes insipidus, the inotrope requirement, hypothermia, electrolyte imbalance, arrhythmia, and cardiac arrest. Among the approximately 2600 patients admitted to the general 24-bed ICU, 940 had cerebral injuries. In this group, the mortality rate was 33.5% (315 out of 940 patients) including brain-dead patients. Donor care was performed in 94 patients with organs suitable for transplantation out of 134 brain-dead patients. Fifty (53.2%) out of 94 patients became organ donors. The donor ratio was 12 per million-population per year as a mean value of the study period, which was approximately 10 times higher than the average ratio in Turkey. Although we observed many life-threatening problems during donor management, none of these patients died or had acute organ dysfunction.
