342.1: Successful delivery of a healthy infant with subsequent recovery and transplant of organs from a brain dead mother following 105 days of maternal somatic support: A case study.

Abstract

Background: A 27 year-old pregnant woman (17 weeks gestation) suffered an anoxic brain injury status post hanging. She was diagnosed brain dead on day 8 of hospitalization; all days listed herein are from admission (day 1) as she was on full ventilator support and under acute critical care from the date of admission. Case Progression: The family expressed a desire for the patient to be an organ donor. Hospital Staff (HS) made an early referral to the organ procurement organization (OPO) on day 4 at the family’s request after they were made aware of the grave prognosis. The OPO, patient’s physician (MD), HS, and ethics huddled to evaluate options for fulfilling the family’s wishes. During initial conversations with the family, the MD made the family aware ethics would need to be involved regarding any decisions to withdraw care or support. Family considered all options including withdrawal of support before ultimately choosing to pursue donation. A literature search revealed that while a brain dead mother had been supported for up to 110 days to achieve a live birth, the longest that such a mother had been supported with the end result of both a live birth and organ donation had been 64 days. The OPO collaborated with the family and a dedicated multidisciplinary hospital staff to develop a strategy to pursue the family’s goals. At a minimum there was daily communication between HS/MD and OPO staff; numerous OPO staff role types were involved. The donor’s water broke on day 19. On day 35 (22 weeks gestation), HS informed OPO staff that if the donor went into labor, it would not be stopped. At 30 weeks gestation, a date was set for a planned Caesarian-section. A huddle was conducted and infectious disease testing was performed. Results: On day 104, a healthy baby was delivered weighing 2212 g at 31.5 weeks gestation. OPO staff then began organ evaluation and on day 105 of maternal somatic support and 98 days after declaration of brain death, 4 organs (kidneys, liver, pancreas) were recovered and successfully transplanted into 3 recipients. All recipients are alive with normal organ function 200 days post-transplant. The newborn infant was discharged home 33 days after delivery with no disability. Conclusions: This landmark case represents the third longest reported case of life support for a brain dead mother to deliver a viable infant. It also represents the longest duration to both deliver a viable infant and provide organs for transplant, exceeding the previous record by 41 days. This case demonstrates that careful collaboration between the OPO and donor hospital can allow families to both achieve delivery of a viable infant and save lives through organ donation. The OPO’s and hospital’s lifesaving mission was met as four individuals (one newborn child and three recipients) are alive 200 days later. Further cases of this type should be carefully evaluated and pursued as an opportunity to support the grieving family and to save lives.