Brain death and postmortem organ donation: report of a questionnaire from the CENTER-TBI study

Ernest Van Veen,Center-Tbi Investigators And Participants ,Inez D De Beaufort,Erwin J O Kompanje,Giuseppe Citerio,Andrew I R Maas,Jeroen T J M Van Dijck,Wim J R Rietdijk,Nino Stocchetti,David K Menon,Maryse C Cnossen,Mathieu Van Der Jagt

doi:10.1186/s13054-018-2241-4

Abstract

BackgroundWe aimed to investigate the extent of the agreement on practices around brain death and postmortem organ donation.MethodsInvestigators from 67 Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study centers completed several questionnaires (response rate: 99%).ResultsRegarding practices around brain death, we found agreement on the clinical evaluation (prerequisites and neurological assessment) for brain death determination (BDD) in 100% of the centers. However, ancillary tests were required for BDD in 64% of the centers. BDD for nondonor patients was deemed mandatory in 18% of the centers before withdrawing life-sustaining measures (LSM). Also, practices around postmortem organ donation varied. Organ donation after circulatory arrest was forbidden in 45% of the centers. When withdrawal of LSM was contemplated, in 67% of centers the patients with a ventricular drain in situ had this removed, either sometimes or all of the time.ConclusionsThis study showed both agreement and some regional differences regarding practices around brain death and postmortem organ donation. We hope our results help quantify and understand potential differences, and provide impetus for current dialogs toward further harmonization of practices around brain death and postmortem organ donation.

Highlights

We aimed to investigate the extent of the agreement on practices around brain death and postmortem organ donation
Practices around brain death When do you declare a patient brain dead? We found agreement on the clinical evaluation for brain death determination (BDD) in 100% of the centers
The clinical evaluation for BDD included: a Glasgow Coma Scale (GCS) of three, absence of brain stem reflexes, no respiratory efforts in response to an apnea test, and absence of confounding factors to Topics covered in this study

Summary

Introduction

We aimed to investigate the extent of the agreement on practices around brain death and postmortem organ donation. The systemic circulation was intact, the brain showed no objective evidence of function. This observation gave rise to the question of what “coma. Brain death and postmortem organ donation are closely linked. An important, and not well investigated, issue van Veen et al Critical Care (2018) 22:306 regarding circulatory arrest organ donation is the hands-off time after circulatory arrest. Consensus regarding practices around brain death and postmortem organ donation could prevent these inconsistencies. To facilitate this consensus, the first step is to document potential differences

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