Predictors of Organ Donation Among Patients With Brain Death in the Intensive Care Unit

• Published in: Transplantation proceedings 2018-06, Vol.50 (5), p.1220-1226
• Main Authors: Nakamura, M.T., Rodio, G.E., Tchaicka, C., Padilha, E.F., Jorge, A.C., Duarte, P.A.D.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; APACHE; Brain Death - blood; Brazil; Cohort Studies; Critical Care; Female; Humans; Intensive Care Units; Male; Middle Aged; Retrospective Studies; Tissue and Organ Procurement - statistics & numerical data; Tissue Donors - supply & distribution; Young Adult
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2018.02.069

Despite the improved care of potential organ donors with probable brain death (BD) in the intensive care unit (ICU), few epidemiologic and clinical data are available in developing countries. To evaluate ICU patients with suspected BD aiming to identify factors possibly related to success (organ donation) or failure (nondonation). Retrospective cohort study, from the patient records of an adult ICU of a Brazilian teaching hospital for 12 months. Data were tabulated, and descriptive statistics and univariate and multivariate analyses were performed. During the study period, 85 patients with acute neurologic diseases and suspected BD were admitted to the ICU and included for analysis. Of these, there were 9 organ donors (7 liver and 9 kidney donors); 77.7% were men, with a mean age of 39.6 years and admission Acute Physiology and Chronic Health Evaluation II of 25.5. Two-thirds of the patients were victims of trauma. The mean time between acute neurologic event and organ withdrawal was 269 hours. The main prognostic factors related to the success of organ donation were the maximum serum lactate and creatinine levels during ICU admission. The main clinical factors correlated with nonevolution for organ donation among ICU patients with clinical suspicion of BD were related to patient severity and organic dysfunction: serum lactate and creatinine level. Clinical care and monitoring are emphasized to improve the efficiency of the donation process. •Despite improved care in recent years, few data are available about management of brain-dead patients in ICU in developing countries.•In a Brazilian cohort of ICU patients with suspected brain death, the main factors associated to failure (non–organ donation) were related to patient's illness severity and systemic organ dysfunction: higher serum lactate and higher creatinine level.•In the donors group, the time between the initial neurologic event (stroke or trauma) and the diagnosis of profound coma (GCS = 3) was lower than in the nondonor group.