Analysis of brain death declaration process and its impact on organ donation in a reference trauma center.

Jorge Tadeu Campos Paixão,Emanuel De Jesus Soares De Sousa,Bruno Lopes Dos Santos-Lobato,Vitor Hugo Nunes Do Nascimento,Maria De Fátima Albuquerque Rodrigues,Marcela Coutinho Alves

doi:10.31744/einstein_journal/2020ao5448

Jorge Tadeu Campos Paixão, Emanuel De Jesus Soares De Sousa + Show 4 more

Open Access

https://doi.org/10.31744/einstein_journal/2020ao5448

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Abstract

ABSTRACTObjective To characterize the processes of brain death diagnosis and organ donation in a reference trauma center.Methods Observational and cross-sectional study with patients notified with brain death at a reference trauma center. Data were obtained through the collection of medical records and brain death declaration forms.Results One hundred fity-nine patients were notified with brain death, mostly male (82.6%), young adults (97.61%) and victims of brain traumatic injury (93.7%). Median of the total time interval for the diagnosis of brain death was 20.75 hours, with no difference between organ donors and non-donors. We had excessive time intervals on brain death declaration, but without statistical effect on organ donation numbers.Conclusion We had low efficacy in brain death declaration based on longer time intervals, with no impact on organ donation.

Highlights

Brain death (BD) can be defined as a clinical manifestation of a cerebral catastrophe, characterized by a complete and irreparable neurological damage, recognized by irreversible coma, absence of brain stem reflexes and apnea.[1]The diagnosis of this condition has important medical, ethical and legal implications, since it may influence the withdrawal of all life-sustaining measures or the recovery of organs for transplantation
Data was obtained by compiling medical records and BD declaration forms in documents of the Organ Procurement Organization (OPO) of patients diagnosed with BD between June 2014 and June 2017
The second BD clinical examination was often performed by neurologists/neurosurgeons (72.3%), and the number of successful organ donations was higher (41.1%) when first BD clinical examination was performed by neurologists/neurosurgeons (χ2=4.18; p=0.04)

Summary

Introduction

Brain death (BD) can be defined as a clinical manifestation of a cerebral catastrophe, characterized by a complete and irreparable neurological damage, recognized by irreversible coma, absence of brain stem reflexes and apnea.[1]. The diagnosis of this condition has important medical, ethical and legal implications, since it may influence the withdrawal of all life-sustaining measures or the recovery of organs for transplantation. In 2017, there was an update on Brazilian law regarding BD declaration (Decree 9,175, of October 18, 2017, and Federal Medical Council Resolution 2,173/17, of November 23, 2017) aiming to increase the number of successful organ donations[7,8] – Westphal et al, offer a comprehensive review about these changes.[9]

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