Factors Affecting Diagnosis of Brain Death and Process of Organ Donation in a University Hospital in Turkey

Abstract

Introduction Diagnosis of brain death and organ donation are a complex process that requires a rapid organization among donor hospital, transplant center, regional coordination center and national coordination center. The aim of this study was to determine the factors affecting the timing of brain death diagnosis and cadaveric organ donation in a university hospital in Turkey. Methods Cases, who were diagnosed with brain death between the years 2015 and 2017 in the intensive care units at the Ondokuz Mayis University Hospital, were enrolled. The cases who were examined retrospectively were evaluated in terms of some factors such as demographics, blood group, being an organ donor, donation time, donation day, donation hour, receiver center and transport time. Results Of the 68 cases, 24 (35.3%) were in the 0-18 age group and 32 (47%) were in the 36-65 age group. Thirty-two (47.1%) cases were diagnosed with subarachnoid hemorrhage. Twenty-one (30.9%) cases were reported to be a forensic case. Fifty-two (76.5%) cases who were diagnosed with brain death were found eligible to donate organs. The process for brain death diagnosis was completed over 24 hours in 61 (89.7%) cases. The declaration was made within the first hour after the diagnosis in 66 (97.1%) cases. The family interview was conducted within the first hour after the declaration in 64 (94.1%) cases. Twenty-one (30.9%) cases became donors. Eleven (52.4%) of the forensic cases became donors and 10 (21.3%) of the non-forensic cases became donors. These ratios were found to be statistically significant (p = 0.01). The interval between organ donor brain death and organ harvesting was between 11 and 24 hours in 10 (14.7%) cases. The harvesting team was outside of the region in 15 (71.4%) of the donors. The waiting period for the harvesting teams outside the region was determined to be 5-8 hours in 8 (11.8%) cases. Conclusion The cadaveric organ donation rate in the Ondokuz Mayis University Hospital was 30.9%. This rate was above the general average of Turkey. Donation occurs up to 24 hours of harvesting, donor organs can be lost and prolonged processes may affect the viability of organs. Since Turkey is a large country with a wide variety of geographical features, it is not always possible that donors and recipients live in the same region. However, we think that this problem can be overcome as the Ministry of Health supports the use of resources for cadaveric organ donation.