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Published on: August 15, 2022
Epidemiological Characteristics and Management of Multi-organ Donors in an Intensive Care Unit: An Eight-Year
Luis Enrique Sanchez García1,2, Nemi Isabel Pérez Peña1,2, Francisco Aguilar Rodríguez1,2
1Transplant and Donation Department, Regional General Hospital 1 of the Mexican Social Security Institute, Queretaro, MEX.
Introduction:
Patients with brain death are the primary source of organs for transplantation worldwide. Recognizing patients with this diagnosis, providing proper care, and effectively managing them in an intensive care unit (ICU) has been shown to increase donation rates in leading countries. The increasing demand for organs compared to the available number for transplantation heightens the responsibility of caring for potential donors.
Methods:
An observational, cross-sectional, descriptive, and retrospective study was undertaken through the analysis of cases involving multiorgan donors diagnosed with brain death. This data was obtained from the coordination of donation and procurement at the Regional General Hospital 1 of the Mexican Institute of Social Security in Querétaro. The study encompassed the duration from January 1, 2016 to December 31, 2023.
Statistical Analysis:
A database was created in the Excel program and subsequently, the analysis of the variables identified was carried out in the IBM SPSS Statics 25 software (IBM Corp., Armonk, NY). Qualitative variables were analyzed using contingency tables, frequency tables, and statistical correlation tables. For quantitative variables, the analysis included averages, percentages, means, medians, modes, variances, and standard deviations.
Results:
A total of 83 patients diagnosed with brain death were identified, of whom 56 became multiorgan donors. Thirty patients were excluded from donation, with the majority (19) due to family refusal. The primary age group was 10-20 years, accounting for 23.21% of cases. The mean age was 34.86 years. 71.43% of donors were male and 28.57% were female. The most frequent admission diagnosis was severe traumatic brain injury (46.43%). 56.6% of patients were admitted to the hospital with a Glasgow Coma Scale (GCS) score of 3 points. Brain death diagnosis was confirmed via angiography in 80.4% of cases. The average length of stay was 3.95 days. The average weight was 71.19 kg. The average height was 166 cm, and the mean BMI was 25.30. Forty patients had blood type O positive, accounting for 71.4%. A total of 255 organs and tissues were procured from 2016 to 2023: 103 kidneys, 97 corneas, 41 livers, six hearts, four skin and bone tissue derivatives, three pairs of lungs, and one heart valve. Hormone replacement therapy was not used in 55.4% of cases. Combined thyroid hormone and steroid regimen was used in nine patients (16.1%), and desmopressin was used in 12 patients (21.4%). During ICU stay, 69.6% of patients required norepinephrine to achieve perfusion goals.
Conclusions:
The epidemiological profile characterizing the multiorgan donor at Regional Hospital 1 in Querétaro was typically male, with a mean age of 34.86 years, no comorbidities, presenting with severe traumatic brain injury upon arrival at the emergency department with a GCS score of 3 points. Norepinephrine was the most commonly used vasopressor, and the majority of patients did not meet hemodynamic criteria for initiating hormone replacement therapy.
