Selection of the Brain-Dead Potential Organ Donor

Background: Organ donation and transplantation represent one of the most important scientific advances over the last decades. Due to the complexity of these procedures and related ethical–legal aspects, however, there are a lot of doubts and uncertainty about the brain death diagnosis and the maintenance of potential organ donor. Aim: To identify and discuss the different meanings and experiences of registered nurses and physicians from an adult intensive care unit in relation to the diagnosis of brain death and the maintenance of potential organ donors for transplantation purposes. Study Design: Participants were registered nurses and physicians from an adult intensive care unit at a University Hospital from Brazil. Data were collected through semi-structured interviews and analyzed using content analysis. Ethical considerations: This study was approved by the University of São Paulo at Ribeirão Preto College of Nursing Research Ethics Committee. Results: Two main categories emerged from the analysis: (1) brain death diagnosis and its implications and (2) maintenance of the potential organ donor and its repercussion in the donation–transplantation process. Six subcategories were also identified: (1.1) understanding the brain death diagnosis as a tool to aid decision-making; (1.2) diagnosis as guarantee of rights; (1.3) difficulties encountered to establish the diagnosis; (1.4) clinical criteria adopted in Brazil and related ethical–legal aspects; (2.1) specificities of care to the brain dead person and outcomes; and (2.2) nurse’s duties toward the brain dead person. Conclusion: Although the brain death diagnosis is scientifically and legally defined in Brazil and the maintenance of the potential organ donor for transplantation purposes has been addressed during the last years, there are still some doubts about the subject, as its understanding varies according to the personal beliefs, culture, and educational background of individuals, including those who work in this scenario.

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Brain Death and Resuscitation of the Organ Donor

10.2310/7ccsp.8029 ◽

2017 ◽

Author(s):

Kasra Khatibi ◽

Chitra Venkatasubramanian

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Brain Death ◽

Organ Donor ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Potential Organ Donor ◽

Brain Dead ◽

Donor After Brain Death ◽

Apnea Testing

When is a patient brain dead? Under what scenarios in the surgical intensive care unit is brain death a possibility? Who can declare brain death and how? What are the steps after brain death declaration? You will find answers to all of these and more in this review. We will walk you through the principles, prerequisites, and techniques of clinical brain death evaluation using checklists and videos. The role and interpretation of ancillary testing and pitfalls are also discussed. New in this section is a description of the techniques that can be adapted when a patient is on extracorporeal membrane oxygenation. In addition, we have included a section on how to communicate effectively (i.e., what phrases to use) with families while discussing brain death and thereby avoid conflicts. We conclude with a detailed section on the physiology and critical care of the potential organ donor after brain death. This review contains 2 videos, 8 figures, 3 tables and 21 references Key words: Brain death, Apnea testing, ECMO, Organ donation

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Life From Death—The Brain Dead Organ Donor Process As an Intersection of Family Bereavement and Needs and Clinician Awareness and Empathy*

Critical Care Medicine ◽

10.1097/ccm.0000000000003674 ◽

2019 ◽

Vol 47 (4) ◽

pp. 606-607

Author(s):

Cherylee W. J. Chang

Keyword(s):

Organ Donor ◽

Brain Dead ◽

The Brain

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Care of the brain-dead organ donor

Current Anaesthesia and Critical Care ◽

10.1016/j.cacc.2007.09.003 ◽

2007 ◽

Vol 18 (5-6) ◽

pp. 284-294 ◽

Cited By ~ 10

Author(s):

Konstantinos Linos ◽

John Fraser ◽

William D. Freeman ◽

Carole Foot

Keyword(s):

Organ Donor ◽

Brain Dead ◽

The Brain

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Physiologic Features of Brain Death

The American Surgeon ◽

10.1177/000313481708300835 ◽

2017 ◽

Vol 83 (8) ◽

pp. 850-854 ◽

Cited By ~ 4

Author(s):

Eno-Obong Essien ◽

Kristina Fioretti ◽

Thomas M. Scalea ◽

Deborah M. Stein

Keyword(s):

Brain Death ◽

Injury Severity ◽

Organ Donor ◽

Respiratory Dysfunction ◽

Traumatic Injuries ◽

Potential Organ Donor ◽

Major Mechanism ◽

Patient Demographics ◽

Widespread Belief ◽

Brain Dead

Brain death is known to be associated with physiologic derangements but their incidence is poorly described. Knowledge of the changes that occur during brain death is important for management of the potential organ donor. Thus, we sought to characterize the pathophysiology that occurs during brain death in patients with traumatic injuries. All brain-dead patients over a 10-year period were identified from the trauma registry at a level 1 urban trauma center. Patient demographics, injury characteristics, and clinical data for defining organ dysfunction were reviewed for the 24 hours surrounding brain-death declaration. Three hundred and seventy-three patients were identified. Mean age was 37 years (617.2). Seventy-five per cent were male. Major mechanism of injury was blunt trauma in 66 per cent. Median injury severity score was 34 (IQR 25–43) with a median head abbreviated injury scale score of 5. The most common physiological disturbance was hypotension with 91 per cent of subjects requiring vasopressors. Thrombocytopenia and acidosis both had an incidence of 79 per cent. The next most common disturbances were hypothermia and moderate-to-severe respiratory dysfunction in 62 per cent. Myocardial injury was seen in 91 per cent but only 5.7 per cent of patients manifested severe cardiac dysfunction with an ejection fraction of <35. Diabetes insipidus was diagnosed in 50 per cent of patients. Interestingly, coagulopathy was noted in only 61.3 per cent, and hyperglycemia was seen in 36 per cent despite widespread belief that these occur universally during brain death. This is the first and largest study to characterize the incidence of pathophysiological disturbances following brain death in humans. Appropriate management of these dysfunctions is important for support of potential brain-dead organ donors.

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Management of the brain-dead organ donor

Trauma Intensive Care ◽

10.1093/med/9780199777709.003.0013 ◽

2013 ◽

pp. 149-154

Author(s):

Kai Singbartl

Keyword(s):

Organ Donor ◽

Brain Dead ◽

The Brain

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