TIMES REQUIRED FOR EACH STEP OF BRAIN DEATH DONOR MANAGEMENT

Abstract

Background: Delayed brain death determination or prolonged time period for donor management cause increasing number of donor death, or withdrawal of family’s consent for donation, and increasing the expenditure of intensive care expenses. In order to prepare a plan to minimize the donation failure by understanding the times required for each step of organ donation is urgent. Methods: From January 2016 to December 2018, we reviewed KODA statistical data of reported potential brain death and investigated the time intervals that take to complete each process of brain death management. Organ donation procedures were divided into five steps. The first step started from the end of the first brain death examination to the end of the second examination, the second step was from finishing the second brain death examination until we got the flat EEG, the third stage was from finishing EEG test to the declaration of brain death by brain death committee, and the fourth stage was from end of committee to entrance to operating room and the fifth step was from the operating room entrance to the completion of organ procurement. Results: During the study period, 1,633 cases of potential brain death were managed for organ donation, and we analyzed 1,594 cases excluding donors under age six. The average time spent on organ donation procedure was 33 hours and 16 minutes. The time required for each step was 11 hours 28 minutes for step1, 5 hours 15 minutes for step2, 5 hours 58 minutes for step3, 6 hours 38 minutes for step4 and 3 hours 42 minutes for step5. Among the analyzed cases, 119 cases spent more than 48 hours from step 1 to 4, and 63 cases those included holidays in the donation process took an average of 71 hours and 5 minutes. Ninety three cases were discontinued during the donation procedure and their causes of interruption were poor organ quality 15 cases, patient death in 15, failure in brain death judgement in 13 and withdrawal of donation consent in six. About time of interruption of donation procedures, 45 cases were stopped at step 1 and 2, and the total times spent for step 1 and 2 was 16 hours and 43 minutes which accounting for half of all brain death donation procedures. In particular, the first step took 11 hours and 28 minutes on average, almost twice as long as the 6 hour legal inspection interval. The third step took an average of six hours, which is unnecessary in foreign countries where there is no brain death judgment committee. Conclusion: Brain death determination procedures should be accurate but not unnecessarily delayed. Among the measures to reduce the time required, improvement of the execution of the first and second brain death examinations which repeat the same test, improvement of delay of the EEG examination to obtain flat wave, and careful approach for abolishing the brain death judgment committee are necessary. Delayed brain death organ donation procedure caused by lack of manpower especially during holidays and night time need a government level policy revision and social consensus.