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Chronological Changes in Causes of Death in Brain Death Donors: A 7-Year Analysis in the Tuscany Region
Chiara Lazzeri1, Marco Bombardi, Manuela Bonizzoli
1>From the Tuscany Regional Transplant Center,Careggi University Hospital Florence,Italy.
Insights
Brain death donor causes shifted towards postanoxic encephalopathy, with fewer traumatic brain injuries. This led to increased organ utilization and more liver and kidney transplants.
Area of Science:
- Transplantation immunology
- Organ donation epidemiology
- Neurology
Background:
- Donation after circulatory death is increasing globally, while brain death donation remains stable.
- Organs from brain-dead donors are crucial for transplantation, but their etiologies are evolving.
- Monitoring changes in brain death causes is vital for organ procurement organizations.
Purpose of the Study:
- To analyze chronological changes in the causes of brain death in donors.
- To assess the impact of these changes on organ utilization and transplant rates.
Main Methods:
- A retrospective analysis of 2877 brain death donors in Tuscany from 2015-2024.
- Comparison of two periods: 2015-2019 (period 1) and 2021-2024 (period 2).
Main Results:
- Postanoxic encephalopathy and "other causes" significantly increased in period 2.
- Traumatic brain injury as a cause of brain death significantly decreased.
- Organ donor utilization and rates of liver and kidney transplants increased in period 2.
Conclusions:
- Etiologies of brain death are dynamic, with a notable rise in postanoxic encephalopathy.
- Increased organ utilization and transplant numbers were observed despite changing donor demographics.
- Continuous monitoring of brain death donor causes is essential for optimizing organ transplantation strategies.
Objectives:
During the past 5 years, donation from donors after circulatory death has increased by 4 % worldwide, whereas donation from donors after brain death has remained unchanged. Organs from circulatory death donors are known to be less performative than organs from brain death donors, and the pool of brain death donors remains the main source of organ transplants in many countries. Chronological changes in the criteria for brain death in donors have occurred in many countries.
Materials And Methods:
We describe chronological changes in causes of death in 2877 brain death donors consecutively assessed in Tuscany from 2015 to 2024. Two different periods were considered: 2015 to 2019 (period 1 ) and 2021 to 2024 (period 2 ).
Results:
Significant increases in postanoxic encephalopathy (P = .037 ) and in "other causes " (P = .002 ) were observed in period 2 versus period 1. A significant decrease in traumatic brain injury (P = .002 ) was also detected. The number of utilized donors significantly increased in period 2 with an increase in liver transplants and kidney transplants.
Conclusions:
Our investigation of a large cohort of brain death donors assessed in the Tuscany region from 2015 to 2024 showed dynamic changes in the etiologies of brain death, mainly with an increase in postanoxic encephalopathy and a reduction in ischemic stroke. Nevertheless, utilization rate increased recently, with a rise in liver transplants and kidney transplants. Our data strongly suggest the importance of transplant authorities to monitor epidemiological changes in causes of death in brain death donors, to identify areas for potential improvement.
