Comparison of 1 vs 2 Brain Death Examinations on Time to Death Pronouncement and Organ Donation

Neurology ◽  
2021 ◽  
Vol 96 (10) ◽  
pp. e1453-e1461
Author(s):  
Panayiotis N. Varelas ◽  
Mohammed Rehman ◽  
Chandan Mehta ◽  
Lisa Louchart ◽  
Lonni Schultz ◽  
...  
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Brain Function ◽  
Brain Injuries ◽  
Organ Procurement ◽  
Tertiary Hospital ◽  
Consent Rate ◽  
Organ Procurement Organization ◽  
Time To Death ◽  
Elapsed Time

ObjectiveTo fill the evidence gap on the value of a single brain death (SBD) or dual brain death (DBD) examination by providing data on irreversibility of brain function, organ donation consent, and transplantation.MethodsTwelve-year tertiary hospital and organ procurement organization data on brain death (BD) were combined and outcomes, including consent rate for organ donation and organs recovered and transplanted after SBD and DBD, were compared after multiple adjustments for covariates.ResultsA total of 266 patients were declared BD, 122 after SBD and 144 after DBD. Time from event to BD declaration was longer by an average of 20.9 hours after DBD (p = 0.003). Seventy-five (73%) families of patients with SBD and 86 (72%) with DBD consented for organ donation (p = 0.79). The number of BD examinations was not a predictor for consent. No patient regained brain function during the periods following BD. Patients with SBD were more likely to have at least 1 lung transplanted (p = 0.031). The number of organs transplanted was associated with the number of examinations (β coefficient [95% confidence interval] −0.5 [−0.97 to −0.02]; p = 0.044), along with age (for 5-year increase, −0.36 [−0.43 to −0.29]; p < 0.001) and PaO2 level (for 10 mm Hg increase, 0.026 [0.008–0.044]; p = 0.005) and decreased as the elapsed time to BD declaration increased (p = 0.019).ConclusionsA single neurologic examination to determine BD is sufficient in patients with nonanoxic catastrophic brain injuries. A second examination is without additional yield in this group and its delay reduces the number of organs transplanted.

Organ Donation, Brain Death and the Family: Valid Informed Consent

2015 ◽  
Vol 43 (2) ◽  
pp. 369-382 ◽  
Author(s):  
Ana S. Iltis
Keyword(s):  
Informed Consent ◽  
Brain Death ◽  
Organ Donation ◽  
Organ Procurement ◽  
Organ Donor ◽  
Public Understanding ◽  
Organ Procurement Organization ◽  
The Family ◽  
Driver's License ◽  
Brain Dead

In July 2013, parents in Ohio objected to their 21-year-old son becoming an organ donor. Elijah Smith was involved in an accident and pronounced dead using neurological criteria. The organ procurement organization (OPO) went to court and argued that because the young man was brain dead and because his driver's license indicated that he wished to be a donor, the court should allow them to use his organs. The mother argued that her son did not understand what he was signing when he signed his license and that his signature did not reflect an informed decision. The court disagreed with her, saying that he had indicated a wish to donate his organs and that no one but Elijah could revoke that wish. His organs were removed.Elijah's mother suspected that he did not understand what he was signing. She might have been right, given what we know about the process for obtaining permission for organ donation and the limited public understanding of brain death.

An In-House Coordinator Program to Increase Organ Donation in Public Trauma Hospitals

1998 ◽  
Vol 8 (2) ◽  
pp. 82-87 ◽  
Author(s):  
Teresa Shafer ◽  
R. Patrick Wood ◽  
Charles Van Buren ◽  
William Guerriero ◽  
Kimberly Davis ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Organ Donation ◽  
Organ Procurement ◽  
Consent Process ◽  
Organ Donors ◽  
Consent Rate ◽  
Donor Management ◽  
Organ Procurement Organization ◽  
Conversion Rates ◽  
Organ Recovery

A 4-year retrospective study was conducted regarding the donor potential, consent rates, and organ recovery at a large 500-bed public trauma hospital. An independent organ procurement organization hired two in-house coordinators, one white and one black, to work exclusively in the hospital. The duties of the in-house coordinators included the following: working with nurses, physicians, and residents to identify donors; closely managing and coordinating the consent process; and assisting organ procurement coordinators in donor management. Following the program's implementation and the use of race-specific requesters, a 64% increase in consent rate resulted along with an overall increase of 94% in the number of organ donors. The consent rate of blacks increased 115%, whereas the number of black organ donors increased 154%. The Hispanic consent rate increased 48% with a corresponding increase of 83% in the number of Hispanic organ donors. In addition, the white consent rate increased from 55% (the 3-year average from 1993 to 1995) to 75% in 1996, resulting in a 36% increase following the implementation of the program. The investment of dedicated race-sensitive personnel in large urban county trauma facilities can result in a significant increase in donor conversion rates.

Increasing Referrals and Donations Using the Transplant Center Development Model

1996 ◽  
Vol 6 (1) ◽  
pp. 32-36 ◽  
Author(s):  
Mark T Gravel ◽  
Penelope Szeman
Keyword(s):  
Organ Donation ◽  
Organ Procurement ◽  
Medical Center ◽  
Development Model ◽  
Tissue Donation ◽  
Staff Education ◽  
Organ Procurement Organization ◽  
Organ And Tissue Donation ◽  
Transplant Center ◽  
Donation Process

Although transplantation centers directly benefit from organ and tissue donation, they continue to yield low organ and tissue referral and donation rates. Our medical center and organ procurement organization developed a model to increase referral and donation rates. This model, called the Transplant Center Development Model, facilitates the donation process, specializes staff education, and promotes administrative involvement. After it was was implemented at our medical center in 1991, the referral and donation rates from 1988 to 1990 were compared with those from 1991 to 1993. The results showed that after implementation of the model, the organ referral mean increased 47%; the organ donation mean, 50%; and the tissue donation mean, 117%. These findings suggest that this model may be a valuable tool in transplant center development.

scholarly journals LO66: Solid organ donation from the emergency department: A death review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S31-S32
Author(s):  
J. McCallum ◽  
R. Yip ◽  
S. Dhanani ◽  
I. Stiell
Keyword(s):  
Emergency Department ◽  
Organ Donation ◽  
Primary Outcome ◽  
Organ Procurement ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Solid Organ ◽  
Organ Donors ◽  
Organ Procurement Organization

Introduction: A significant gap exists between the number of people waiting for an organ and donors. There are currently 1,628 people awaiting organ donation in Ontario alone. In 2018 to date, 310 donors have donated 858 organs. The purpose of this study was to determine whether there were missed donors in the Emergency Department (ED) and by what percent those missed donors would increase organ donation overall. Methods: This was a health records and organ donation database review of all patients who died in the ED at a large academic tertiary care center with 2 campuses and 160,000 visits per year. Patients were included from November 1, 2014 – October 31, 2017. We collected data on demographics, cause of death, and suitability for organ donation. Data was cross-referenced between hospital records and the provincial organ procurement organization called Trillium Gift of Life Network (TGLN) to determine whether patients were appropriately referred for consideration of donation in a timely manner. Potential missed donors were manually screened for suitability according to TGLN criteria. We calculated simple descriptive statistics for demographic data and the primary outcome. The primary outcome was percentage of potential organ donors missed in the Emergency Department (ED). Results: There were 606 deaths in the ED from November 1, 2014 – October 31, 2017. Patients were an average of 71 years old, 353 (58%) were male, and 75 (12%) died of a traumatic cause. TGLN was not contacted in 12 (2%) of cases. During this period there were two donors from the ED and 92 from the ICU. There were ten missed potential donors. They were an average of 67 years, 7 (70%) were male, and 2 (20%) died of a traumatic cause. In all ten cases, patients had withdrawal of life sustaining measures for medical futility prior to TGLN being contacted for consideration of donation. There could have been an addition seven liver, six pancreatic islet, four small bowel, and seven kidney donors. The ten missed ED donors could have increased total donors by 11%. Conclusion: The ED is a significant source of missed organ donors. In all cases of missed organ donation, patients had withdrawal of life sustaining measures prior to TGLN being called. In the future, it is essential that all patients have an organ procurement organization such as TGLN called prior to withdrawal of life sustaining measures to ensure that no opportunity for consideration of organ donation is missed.

Factors that affect consent rate for organ donation after brain death: A 12-year registry

2020 ◽  
Vol 416 ◽  
pp. 117036 ◽  
Author(s):  
Mohammed F. Kananeh ◽  
Paul D. Brady ◽  
Chandan B. Mehta ◽  
Lisa P. Louchart ◽  
Mohammed F. Rehman ◽  
...  
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Consent Rate ◽  
Donation After Brain Death

scholarly journals Dificuldades dos enfermeiros no cuidado ao paciente com morte encefálica

2019 ◽  
Vol 9 (28) ◽  
pp. 19-25
Author(s):  
Veronica Silva de Souza Matos ◽  
Maria Imaculada Cardoso Sampaio
Keyword(s):  
Health Services ◽  
Brain Death ◽  
Organ Transplantation ◽  
Nursing Care ◽  
Organ Procurement ◽  
Integrative Review ◽  
Organ Procurement Organization ◽  
The Difference

Compreender quais são as atribuições do enfermeiro na assistência ao paciente com morte encefálica e expor as dificuldades desses profissionais que são indispensáveis nos serviços de saúde. Trata-se de uma revisão integrativa, construída a partir de materiais já publicados, especificamente artigos científicos, entre 2008 e 2018.  Foram consultadas as fontes BVS e SCIELO. Logo após a busca, foram identificados 10 artigos relevantes para este estudo. Concluiu-se a importância e a diferença que este profissional proporciona nos casos de paciente com morte encefálica, sendo este profissional que muitas vezes notifica a existência de um paciente com morte encefálica para a organização de procura de órgãos ou central estadual de transplante.Descritores: Morte Encefálica, Cuidados de Enfermagem, Transplante de Órgãos. Nursing difficulties do not care for the patient with encephalic deathAbstract: To understand the nurse's role in assisting the patient with brain death and to explain the difficulties of these professionals that are indispensable in health services. It is an integrative review, built from materials already published, scientific articles between 2008 and 2018. The sources VHL and SCIELO were consulted. Soon after the search 10 relevant articles were identified for this study. It was concluded the importance and the difference that this professional provides in cases of patients with brain death, being this professional that often reports the existence of a patient with brain death for the organ procurement organization or state transplant center.Descriptors: Brain Death, Nursing Care, Organ Transplantation. Dificultades de los enfermeros en el cuidado al paciente con muerte encefálicaResumen: Comprender cuáles son las atribuciones del enfermero en la asistencia al paciente con muerte encefálica y exponer las dificultades de estos profesionales que son indispensables en los servicios de salud. Se trata de una revisión integrativa, construida a partir de materiales ya publicados, artículos científicos entre 2008 y 2018. Se consultó a las fuentes BVS y SCIELO. Después de la búsqueda se identificaron 10 artículos relevantes para este estudio. Se concluyó la importancia y la diferencia que este profesional proporciona en los casos de paciente con muerte encefálica, siendo este profesional que muchas veces notifica la existencia de un paciente con muerte encefálica para la organización de demanda de órganos o central estadual de trasplante.Descriptores: Muerte Cerebral, Cuidado de Enfermería, Trasplante de Órganos.

scholarly journals Organ Donation in the Context of Brain Death in Muslim Countries: Bioethical Positions

2020 ◽  
Vol 5 (07) ◽  
pp. 222-224
Author(s):  
Alqahtani Ibtesam Mohammed
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Organ Transplantation ◽  
Organ Procurement ◽  
Modern Medicine ◽  
Organ Transplants ◽  
Clear Cut ◽  
Muslim Countries ◽  
The Right ◽  
End Stage

One of the miracles of modern medicine for patients with end stage organ failure is organ transplantation. The Organ Procurement and Transplantation Network (OPTN) defines organ donation as giving an organ, tissue, cells, or part of an organ from a living or deceased person (i.e., the donor) to a living person in need (i.e., the recipient). In the last two decades, the number of organ transplants has gradually increased; however, the demand for organ transplantation exceeds the number of available donors. Organs from brain dead donors have been suggested as an alternative option for increasing donation rates when living donors are not available. This article explores the debate surrounding brain death organ donation in Muslim countries. Because organ transplantation is based on Ijtihad, Muslim jurists have no clear-cut text in the Holy Quran or Sunna to use as a foundation for judgment. This has made organ transplants an issue among Muslim scholars and researchers, splitting them into two opinion groups, with one side seeing organ transplantation as legal and the other believing it to be illegal. However, all individuals have the right to choose whether they want to help others by sacrificing parts of themselves and donating their organs. Autonomy, justice, and beneficence must be employed in organ transplantation decision-making.

scholarly journals 539: ORGAN DONATION ON ECMO: A DESCRIPTIVE ANALYSIS OF AN ORGAN PROCUREMENT ORGANIZATION DATABASE

2021 ◽  
Vol 50 (1) ◽  
pp. 261-261
Author(s):  
Nina Fainberg ◽  
Wynne Morrison ◽  
Sharon West ◽  
Richard Hasz ◽  
Matthew Kirschen
Keyword(s):  
Organ Donation ◽  
Organ Procurement ◽  
Descriptive Analysis ◽  
Organ Procurement Organization

scholarly journals Organ Donation and Elective Ventilation: A Necessary Strategy

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Dolores Escudero ◽  
Jesus Otero ◽  
Begoña Menéndez de León ◽  
Marcos Perez-Basterrechea
Keyword(s):  
Intensive Care Unit ◽  
Brain Death ◽  
Organ Donation ◽  
High Probability ◽  
Brain Injuries ◽  
Effective Strategy ◽  
Legal Basis ◽  
Risk Of Death ◽  
Willingness To Donate ◽  
Imminent Risk

Organ transplantation is the sole treatment to improve or save the life of patients with final-stage organ failure. The shortage of available organs for transplantation constitutes a universal problem, estimating that 10% of patients on waiting lists die. Brain death is an undesirable result; nevertheless, it has beneficial side-effects since it is the most frequent source of organs for transplantation. However, this phenomenon is relatively uncommon and has a limited potential. One of the options that focuses on increasing organ donation is to admit patients with catastrophic brain injuries (with a high probability of brain death and nontreatable) to the Intensive Care Unit, with the only purpose of donation. To perform elective nontherapeutic ventilation (ENTV), a patient’s anticipated willingness to donate organs and/or explicit acceptance by his/her relatives is required. This process should focus exclusively on those patients with catastrophic brain injuries and imminent risk of death which, due to its acute damage, are not considered treatable. This article defends ENTV as an effective strategy to improve donation rate, analyzing its ethical and legal basis.

The Timing Factor in the Consent Process

1996 ◽  
Vol 6 (2) ◽  
pp. 84-87 ◽  
Author(s):  
Patricia A Niles ◽  
Burton J Mattice
Keyword(s):  
Organ Donation ◽  
Medical Profession ◽  
Organ Procurement ◽  
Organ Donor ◽  
Apparent Difference ◽  
Next Of Kin ◽  
Consent Rate ◽  
Family Approach ◽  
The Family ◽  
Organ Procurement Organizations

Organ procurement organizations have been educating the medical profession on the importance of timing during the donation request process. Separating the request for donation from the notification of death has been encouraged when approaching families for consent for organ donation. This study evaluated the timing of the family approach and consent rates. A 23-month study was performed on all organ donor referrals in a 1.1 million population base. During the study period there were 203 referrals: 67 were medically unsuitable, next-of-kin was not available in 2 cases, 7 were coroner refusals, and 127 were suitable for donation. In this latter group, families were offered the option of organ donation. No apparent difference when donation was requested before or after the death pronouncement was found. Data indicated, however, that when the family is told of the death and is asked for donation simultaneously, the consent rate decreases 32% to 37%.

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