Cause Of Brain Death Research Articles

6394 Prevalence of Diabetes Insipidus in Pediatric Patients Who Have Been Declared Dead by Neurologic Criteria

Abstract Disclosure: C.E. Larancuent: None. V. Merilan: None. M. Leoncio: None. J.M. Lozano: None. B.R. Totapally: None. Introduction: Death by neurological criteria (DNC) or brain death (BD), occurs in individuals who have sustained catastrophic brain injury and are in permanent coma with loss of all brainstem function, coupled with the inability to breathe in the setting of hypercarbia and acidosis. Diabetes insipidus (DI) occurs in many but not all patients with DNC. Several studies indicate varying prevalence rates of DI among pediatric patients with DNC. Objective: Our objective was to determine the prevalence of DI in children who have been declared DNC, and the frequency of DI in these children according to the mechanism of brain injury. Methods: A retrospective analysis of 57 pediatric inpatients 0-21 years subsequently declared BD at Nicklaus Children’s Hospital from January 2013 to June 2023. Data was gathered from the hospital's electronic medical records and the VPS database. The primary exposure is brain death, while the secondary exposure is the mechanism of brain injury. These injuries were categorized into anoxic, traumatic brain injury (TBI), and brain tumors/space-occupying lesions (malignancy). The prevalence of DI was assessed as the primary outcome, and it was compared between three etiologies for brain death using Pearson Chi-square. Due to the study's small sample size, the association between the cause of BD and DI was not adjusted by covariates, such as sex and age. This study was exempted by the IRB. Results: Of the 53 patients declared BD, 47 (88.7%, 95% CI 77.9% to 95.3%) were diagnosed with DI. The prevalence of DI did not change significantly according to the etiology of brain injury leading to BD (84.4%, 100.0%, and 92.3% for anoxic brain injury, TBI, and malignancy, respectively; p = 0.410). The characteristics of children according to the etiology of brain death are presented in Table 1. The characteristics of children according to the development of DI are presented in Table 2. ICU length of stay, the duration to brain death declaration, and eligibility for organ donation varied with the etiology of brain death (Table 1). Conclusions: The prevalence of DI is high in pediatric patients declared BD, and it is not significantly different based on the etiology of brain death. Given this high prevalence, diligent DI management is needed to improve organ donation outcomes. Presentation: 6/2/2024

Analysis of Notifications Received by Central de Transplantes in the State of Roraima from 2017 to 2021

Objectives: To analyze brain death (BD) notifications received by Central de Transplantes (CET) in the state of Roraima (RR) from 2017 to 2021. Methods: This is a cross-sectional, quantitative, and observational study, where all notifications received by CET from 2017 to 2021 were analyzed, resulting in 120 patients from health the following centers: Hospital Geral de Roraima (HGR), Hospital Confederação Nacional das Cooperativas Médicas (UNIMED), Hospital da Criança Santo Antônio (HCSA), Hospital das Clínicas (HC), and Hospital Lotty Íris (HLI). The data were collected from the center’s data management system and passed on to the collection form developed by the researcher. Results: This study analyzed 119 notifications after excluding one due to conflicting data. There was a predominance of males (58%), with traumatic brain injury being the most frequent cause of BD. Six organ harvestings were carried out, all at the HGR. This study found no significant associations between organ procurement and sex, age, place of hospitalization, and year. Conclusion: There are considerable challenges concerning organ donation in RR, with a low uptake rate over five years. Only the HGR successfully carried out organ harvesting, while other reporting hospitals were unsuccessful. Improvements are needed, highlighting the importance of more studies for a more in-depth data analysis.

The use of quantitative pupillometry in brain death determination: preliminary findings

PurposeQuantitative pupillometry (QP) has been increasingly applied in neurocritical care as an easy-to-use and reliable technique for evaluating the pupillary light reflex (PLR). Here, we report our preliminary findings on using QP for clinical brain death (BD) determination.MaterialsThis retrospective study included 17 patients ≥ 18 years (mean age, 57.3 years; standard deviation, 15.8 years) with confirmed BD, as defined by German Guidelines for the determination of BD. The PLR was tested using the NPi®-200 Pupillometer (Neuroptics, Laguna Hill, USA), a handheld infrared device automatically tracking and analyzing pupil dynamics over 3 s. In addition, pupil diameter and neurological pupil index (NPi) were also evaluated.ResultsIntracerebral bleeding, subarachnoid hemorrhage, and hypoxic encephalopathy were the most prevalent causes of BD. In all patients, the NPi was 0 for both eyes, indicating the cessation of mid-brain function. The mean diameter was 4.9 mm (± 1.3) for the right pupil and 5.2 mm (±1.2) for the left pupil.ConclusionsQP is a valuable tool for the BD certification process to assess the loss of PLR due to the cessation of brain stem function. Furthermore, implementing QP before the withdrawal of life-sustaining therapy in brain-injured patients may reduce the rate of missed organ donation opportunities. Further studies are warranted to substantiate the feasibility and potential of this technique in treating patients and identify suitable candidates for this technique during the BD certification process.

The Frequency of Organ Donation and the Clinical Characteristics of Donors with Brain Death before and after the Outbreak of the COVID-19 Pandemic in Rasht, Iran

Background The COVID-19 pandemic caused changes in daily life and disrupted hospital performance and the provision of medical services, especially in the organ transplant departments. Objective This study aims to compare the frequency of organ donation and transplantation before and after the COVID-19 outbreak in the transplant centers of northern Iran. Methods This cross-sectional study was conducted on 75 donors with brain death from 2018 to 2021 in Rasht. Demographic data, underlying diseases, history of smoking and drug use, causes of brain death, type of donated organ, number of donated organs per patient, type of transplanted organ, and the location of transplantation (in or out of the province) were recorded. Then, these factors were compared between two time periods: Before the pandemic (from July 2018 to February 2020) and during the pandemic (from February 2020 to August 2021). The recorded data was analyzed in SPSS software, version 21. The significance level was set at 0.05. Results The mean age of donors during the pandemic was significantly higher than that of patients before the pandemic (P<0.001). The most common cause of brain death in donors before the pandemic was trauma; after the pandemic, cerebrovascular causes were more common (P=0.01). The frequency of organ donation and the mean number of donated organs per donor during the pandemic were significantly lower than before the pandemic (P<0.001). Conclusion The COVID-19 pandemic has significant impact on the process of organ donation and transplantation in northern Iran.

Barriers to Deceased Donor Procurements: The Saudi Experience.

Barriers to Deceased Donor Procurements: The Saudi Experience.

Evaluation of organ donation process and affecting factors in COVID-19 pandemic

Objectives: More than six million people worldwide are affected by end-stage organ failure and the COVID-19 pandemic has dramatically changed organ and tissue donation. Methods: The data of patients diagnosed with brain death between July 2018-March 2020 (pre-pandemic period) and April 2020-December 2021 (pandemic period) were analyzed retrospectively. Donor characteristics, laboratory levels, time from intensive care admission to determination of brain death, time to family approval, family approval rates and organ types were analyzed. Results: The mean age of 56 patients with pre-pandemic diagnosis of brain death was 61.82 ± 21.39 years, 37 (63%) patients were donors and 53 organs were obtained. Mean age of 39 patients diagnosed with brain death during the pandemic was 58.26 ± 18.02 years and 38 organs were obtained from 21 (52.5%) donors. Between the two periods, there was a decrease of 30.35% in the diagnosis of brain death, 43.24% in the number of donors and 26.41% in the number of organs supplied. The most common cause of brain death was intracranial hemorrhage during both periods. While the time elapsed between family interview and surgery was 9.33 ± 2.19 hours before the pandemic, it was 15.29 ± 4.28 hours during the pandemic period (p = 0.01). There was a significant difference between C-reactive protein levels at the time of diagnosis of brain death (p < 0.05). Staphylococcus haemolyticus was most frequently seen in blood culture. Conclusions: Brain death and organ donation have decreased significantly during the pandemic period compared to previous years, similar to research conducted in different countries and regions. Due to COVID-19, prolonged stays in the intensive care unit (ICU) may pose a risk of infection in ICU donors, and care should be taken in terms of donor loss.

Evaluation of Optic Nerve Sheath Diameter for Prediction of the Development of Brain Death in Patients Admitted to the Intensive Care Unit with Intracranial Hemorrhage

Intracranial hemorrhage results in an increase in intracranial pressure, which is considered to be the leading cause of brain death. Follow-up of these patients and early recognition of possible brain death are important for organ donation. It has been shown that increased intracranial pressure is proportional to the changes in optic nerve sheath diameter. The aim of this study was to investigate the usability of changes in optic nerve sheath diameter secondary to increased intracranial pressure as a precursor for identification of patients who will develop brain death. Patients admitted to the intensive care unit with intracranial hemorrhage and a Glasgow Coma Scale score of 7 or less were divided into 3 groups: brain death group (patients with brain death), hemorrhage group (patients who died due to hemorrhage), and survivor group (patients who were discharged from the intensive care unit). Optic nerve sheath diameter was measured by computed tomography taken at admission. The highest value for optic nerve sheath diameter was measured in the brain death group (P < .001). The cutoff point for optic nerve sheath diameter to predict the presence of brain death was determined as >6.62 mm. The area underthe curve for optic nerve diameter was 0.85 (sensitivity 66.20%, specificity 90%; P < .001). The results showed a 25.529- fold increased risk of brain death in measurements above this value. An optic nerve sheath diameter value of >6.62 mm measured on initial cranial computed tomography of patients admitted to the intensive care unit with a diagnosis of intracranial hemorrhage is indicative of an increased risk of brain death.

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals.

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals.

Is there any relationship between red blood cell distribution width and prognosis of brain death?

Accumulating evidence has demonstrated that RDW (red blood cell distribution width) may independently predict clinically important outcomes in many populations. However, the role of RDW has not been elucidated in brain death. We conducted this study with the aim of evaluating the predictive value of RDW in brain death. A retrospective study of seventy-seven of brain death cases during 36 months were evaluated at university hospitals, affiliated in Tehran, Iran. Demographical data include age, sex, BMI and cause of brain death, also laboratory results (red blood cell distribution, mean corpuscular volume, hemoglobin) collected by checklists from patient records. Having the three RDW measurements (days of hospital admission, day of brain death, and day of cardiac arrest) required. Time interval from hospital admission until brain death was 5.27±4.07. The mean age of brain death cases was 32.65±16.53. The mean RDW values on days of hospital admission, the day of brain death, and the day of cardiac arrest were 14.53±1.98, 15.12±1.93 and 15.18±2.07, respectively. Results of the repeated-measures ANOVA test reveal that RDW level was constantly higher in the traumatic patient group compared to the non-traumatic ones (P=0.008). The frequency of brain death was high in patients with high RDW values. RDW might be a prognostic biomarker for brain death. More prospective studies with large sample size and long follow-up period should be carried out to determine the prognostic significance of RDW and brain death in future.

316.11: HLA-DPB1 Molecular Mismatches Are Associated With Acute Rejection and Long-term Graft Function in First Kidney Transplants

Introduction: It is generally accepted that HLA-DP mismatches (MM) do not impact the survival of first transplants but that they may exert a deleterious effect in retransplants. This study aimed to investigate the impact of HLA-DPB1 allele and molecular MM (mMM) on the occurrence of acute rejection (AR) and low 5-year graft function (5-yGF) in first kidney transplants (KT). Method: HLA-DPB1 allele and mMM were determined in 130 first KT from deceased donors, performed between 2014 and 2016. The following mMM models were investigated: expression MM, with the high expression G allele in the donor, T cell epitope (TCE) MM, classified as permissive and nonpermissive MM, epitope MM (EMM), considering all six HLA-DPB1 hypervariable regions (EMM-ABCDEF HVR) or only ABEF regions (EMM-ABEF HVR), Eplet MM (EpMM), considering all or only antibody-verified (AbVer) eplets, and solvent accessible amino acid MM (SAMM). EMM, EpletMM and SAMM loads were categorized using thresholds determined by ROC analysis for each outcome. The outcomes were AR and 5-yGF (estimated by CKD-EPI). Logistic and Cox regressions were used to investigate variables associated with 5-yGF and AR, respectively. Results: 119 (91.5%) KT were performed with one or two HLA-DPB1 allele MM. The overall incidence of AR was 17.7% and the median 5-yGF was 40.3 (27.0 - 51.7) mL/min/1.73m2. No association between HLA-DPB1 allele MM and 5-yGF or rejection was observed. Considering only recipients of standard criteria donor, five logistic models for 5-yGF were built including variables that reached a p-value <0.10 in the univariable analysis (age and donor sex, cause of brain death, ABDR MM and AR) and the mMM (TCE, SAMM, all and AbVer EpMM, EMM-ABCDEF and ABEF HVR). In the model 2, variables associated with 5-yGF≤ 40 were donor age (OR=1.08; CI95%=1.02-1.14; p=0.005) and SAMM≥7 (OR=4.40; CI95%=1.56-12.36, p<0.005), while in the model 4, donor age (OR= 1.09; CI95%=1.03-1.15; p=0.003) and EpMM(AbVer≥2 (OR=3.39; CI95%=1.2-9.45, p=0.02) were associated with low GF. The AUC-ROC for predicting 5-yGF was 0.83 (0.75-0.92) for the model 2, and 0.68 (0.57-0.79) for the model 4. Lastly, for the outcome AR in all recipients, beyond the final donor creatinine, the following mMM models were statistically significant: TCE (HR=3.01; CI95%=1.33-6.84; p=0.008), SAMM≥5 (HR=2.69; CI95%=1.10-6.56; p=0.03), AbVerEpMM ≥3 (HR=3.38; 95%CI=1.32-8.70; p=0.01), and EMM-ABCDEF HVR ≥ 6 (HR=5.08; 95%CI=2.19-11.82; p<0.001). Conclusion: To the best of our knowledge, this is the first study that shows that some mMM, in contrast to classical allele HLA-DPB1 MM, are associated with acute rejection and long-term graft function in a population of exclusively first kidney transplants.

"A Comparative Analysis of the Number of Organ Retrievals in Relation to Potential Donation Qualifications in Populations of Patients From a Single Anesthesiology and Intensive Care Unit in 2017-2018".

The population of patients declared as brain dead and qualified for organ donation is relatively low in Poland. The main causes of brain death include cerebral vascular diseases and brain trauma (54 and 34%, respectively, according to Poltransplant registry data). The number of organ procurements in Poland is constantly recorded on average at 14 donations per 1 million citizens (14/mln) in 2017 and 12 donations per one million in 2018. It is difficult to precisely define the number of patients who meet the criteria for brain death certification. The authors have retrospectively analyzed the medical data of 229 patients from 2017 and 2018 records with the aim of identifying potential organ donors among patients of the Intensive Care Unit (ICU) in the University Hospital in Western Poland. Brain death was suspected in 53 patients (23.14%). Brain imaging to confirm no cerebral flow (which is consistent with brain death) was performed in 17 patients (7.45%) and this, as a result, led to organ donation in 9 cases (3.93%). The factors identified as having a positive influence on organ donation included: daily thorough physical examination, (Glasgow Coma Scale) GCS assessment, depth and duration of sedation, ICU length of stay and early performance of a CT-angiogram.

Retrospective Evaluation of Optic Nerve Sheath Diameters of Patients Diagnosed With Brain Death

Introduction: Aim of the study is to investigate whether there is a correlation between causes of brain death, blood gas parameters before and after the apnea test and optic nerve sheath diameter (ONSD).&#x0D; Method: The records of 92 patients with brain death diagnosis were retrospectively analyzed for ONSD measurements of the right and left eyes, partial carbon dioxide pressure (pCO2), blood gas parameters before and after the apnea test. &#x0D; Results: Subarachnoidal hemorrhage and intracerebral hemorrhage were the two most common brain death etiology. Mean ONSD for right eye was 6.37±1.03 mm. Mean ONSD for left eye was 6.43±1.02 mm. Only 8 patients had ONSD below 5.00 mm. There was no statistically significant correlation between the percent change of pCO2 and ONSD change (p&gt;0.05).&#x0D; Conclusion: The present study shows that ONSD values are very high regardless of the partial pressure of carbon dioxide in patients with brain death diagnosis. We can suggest that ONSD can find itself a place for evaluating comatose patients for brain death diagnosis.

Retrospective Analysis of 1998 Patients Diagnosed with Brain Death between 2011 and 2019 in Turkey

Abstract Background Organ transplantation reduces mortality and morbidity in patients with end-stage organ failure. The number of living organ donations is not enough to meet the current organ transplantation need; therefore, there is an urgent need for organ donation from cadavers. We aimed to determine the organ donation rates and reveal the obstacles against donation. Methods This study is designed as a retrospective multicenter study consisting of eight university hospitals, three training and research hospitals, 26 state hospitals, and 74 private hospitals in nine provinces in Turkey. A total of 1,998 patients diagnosed with brain death between January 2011 to April 2019 were examined through the electronic medical records data system. Results Median patient age was 38 (IQR: 19–57), and 1,275 (63.8%) patients were male. The median time between the intensive care unit admission and brain death diagnosis was 56 (IQR:2–131) hours. The most commonly used confirmatory diagnostic test was computed tomography in 216 (30.8%) patients, and the most common cause of brain death was intraparenchymal hemorrhage with 617 (30.9%) patients. A total of 1,646 (82.4%) families refused to permit organ donation. The most common reasons for refusal were family disagreement (68%), social/relative pressure (24%), and religious beliefs (8%). Conclusions Many families refuse permission for organ donation; some of the provinces included in this study experienced years of exceptionally high refusal rates.

Incidence of Donor Hepatic Artery Thrombosis in Liver Grafts Recognized During Organ Procurement and Backtable: A Rare but Treacherous Pitfall In Liver Transplantation

Donor hepatic artery thrombosis (dHAT) identified during liver procurement and backtable is a rare and little-reported event that can make liver transplants unfeasible. This is a retrospective study of dHAT identified during liver grafts procurements or backtable procedures. All grafts were recovered from brain-dead donors. The demographic characteristics of the donors and the incidence of dHAT were analyzed. The data were also compared to a cohort of donors without dHAT. There was a total of 486 donors during the study period. The incidence of dHAT was 1.85% (n=9). The diagnosis of dHAT was made during procurement in 5 cases (55.5%) and during the backtable in 4 (44.4%). Most donors were female (n=5), with an average BMI of 28.14 ± 6.9 kg/m2, hypertensive (n=5), and with stroke as cause of brain death (n=8). The most prevalent site of dHAT was a left hepatic artery originating from the left gastric artery (n=4). Of the 9 cases reported, 2 livers were used for transplantation, and 7 were discarded. Comparing those cases to a cohort of 260 donors without dHAT, we found a higher incidence of anatomic variations in the hepatic artery (P=.01) and of stroke as cause of brain death (P=.05). The occurrence of dHAT before liver procurement is a rare event, however it may become a treacherous pitfall if the diagnosis is late. Grafts with anatomic variations recovered from women with brain death due to stroke and with past history of hypertension seem to be at a higher risk of presenting dHAT.

Cardiac Transplantation Italian Allocation System Analysis: Single Center Results

<h3>Purpose</h3> Analyze the characteristic of donors and recipients in our center and the results of heart transplantations for the two different levels of priority according to Italian previous allocation system, urgent patients and elective ones. <h3>Methods</h3> From 2006 to August 2020, 306 heart transplantations were performed at our institution. Of them 54 (17.6%) in urgency. Reasons for urgency were: 24 patients on ECMO support, 8 on IABP and 13 on intravenous inotropes, 4 arrhythmic storms and 5 complicated LVAD. <h3>Results</h3> In the urgent population, recipients were predominantly male (68.5 % vs 77.4 % in the elective p=0.17) and significantly younger (46.4 vs 52.2 years, p=0.001). More patients were on ECMO support (42.6% vs 1.7% p=0.000), IABP (42.6 vs 6.7% p=0.000) and mechanically ventilated (46.2% vs 6% p=0.000) pre transplant. The donors of urgent patients were younger than donors of the elective ones (38.9 vs 42.4 years (p=0.06). Donor's gender (68% males) and cause of brain death (brain trauma 44,4%, and cerebral hemorrhage 35,2%) were comparable in the two groups. Mean ischemic time was longer in urgent cases (211 vs 191 minutes, p=0.01) as donations came from across the whole country. Severe Early Graft Failure (EGF) requiring ECMO occurred in 9.4% of patients in the urgent population vs 3.6% in the elective with no significant difference (p=0.076), as well as in hospital mortality that was 11.5% in urgent vs 8.3% (p=0.429). Recipients' risk factors for in-hospital mortality were age [OR 1.05 (1.01;1.09), p=0.028] and Glomerular Filtration Rate (GFR) < 40 ml/min [2.68 (1.04;6.92), p=0.047]. No donors' variable resulted to be a risk factor for in-hospital mortality. Episodes and grade of rejection did not diverge between groups, and so did follow up mortality (16.7% in urgent vs 22.4% in electives p=0.444) Mean follow up time for urgent population was shorter (53.6 vs 75.6 months (p=0.007). Overall 5 and 10 years' mortality was 79.7% and 62% vs 88.1% and 72.8% for urgent and elective patients respectively (p=0.721). <h3>Conclusion</h3> This retrospective analysis of our transplantation activity with the different priority regimen shows little differences in terms of mortality and complications. Despite the worse clinical characteristics of the urgent recipients and the longer ischemic time, results do not significantly differ from the elective population, underlying the importance of donation quality.

Factors Influencing Survival Outcome in Deceased Renal Transplant Recipients

Background: Renal replacement therapy is the gold standard treatment of end-stage renal disease. Since the number of cases of chronic kidney diseases are increasing exponentially in our country, only live-related transplant is not enough to bridge the gap between disease and their treatment which increased the demand for deceased renal transplant program in our country. Objective: The objective is to study donors and recipients' characteristics for association with survival of patients in deceased renal allograft transplant. Materials and Methods: It is an ambispective observational analysis of 42 deceased donor renal transplants performed in our institute from January 2012 to December 2019. The difference among donors and recipients' characteristics was analyzed for association with the outcome for survival or death of the patient. Statistical analysis was done using SSPS 21.0 software and P value &lt; 0.05 was taken as statistically significant. Results: In association with survival and expired outcomes, donors and recipients age, donors sex, cause of brain death (traumatic/nontraumatic), standard or extended criteria of donor, serum creatinine at the time of death, dialysis vintage period, warm and cold ischemia time, duration of hospital stay had shown no significant association with survival. While donors' urine output at the time of death, recipients sex, previous sensitization of recipients either by previous episodes of blood transfusion or pregnancy, achievement of normal renal function at day 14 of transplant, and tacrolimus level at 1 month of transplant shown significant association with the outcome. Conclusion: Deceased donors' characteristics, mainly urine output at death, recipients characteristic, namely any previous sensitization, achievement of normal renal function at day 14, serum tacrolimus level at 1-month posttransplant have a significant association with survival of deceased renal allograft transplant recipients. Sepsis and severe acidosis were the main complications contributing to mortality.

The influence of socioeconomic factors on deceased organ donation in Iran.

BackgroundThere is a large gap between the number of patients on organ waiting lists and the number of available organs for donation. This study investigated the socioeconomic factors in Iran that influenced decisions for organ donation among the families of brain-dead donors.MethodsThis retrospective cross-sectional study was performed among the families of 333 organ donors in Iran. Two trained researchers interviewed family members about the donor’s age, sex, cause of brain death, education level, marital status, number of children, history of addiction, the financial status of the donor’s family, and reasons for which they considered refusing organ donation.ResultsThe mean age of the donors was 37.23±16.59 years. During 2017–2019, significant differences were found according to income (P<0.001), marital status (P<0.001), sex (P=0.04), and occupation (P=0.04). More than half of the organ donors were of low socioeconomic status, and nearly half were the sole income earners of large families. Trauma was the most common cause of death (44.6%). The most common reasons for which the families considered refusing organ donation were unfamiliarity with the concept of brain death, denial, and the expectation of a miracle.ConclusionsThe donor’s socioeconomic status and availability of social services, such as insurance coverage, psychological services, and mourning therapy courses, play an important role in organ donation. Adequate support for the deceased’s family after organ donation is imperative.

Association of Donor Brain Death Due to Stroke With Prognosis After Heart Transplantation

BackgroundThe proximate cause of donor brain death is not considered a conventional risk factor in modern heart transplantation. ObjectivesThis study aimed to investigate the effect of the cause of donor brain death on recipients. MethodsUsing the United Network for Organ Sharing registry, long-term mortality and allograft failure were compared in recipients who underwent heart transplantation in the United States from 2005 through 2018 between allograft recipients from donors with stroke as the cause of brain death (n = 3,761) vs nonstroke causes (n = 14,677). Inverse probability weighting was used for risk adjustment. Interactions were investigated between the cause of brain death and other conventional donor risk factors for recipient mortality. ResultsThere was an interaction between the cause of brain death and donor age (Pinteraction = 0.008). When allografts were procured from donors aged 40 years or younger, stroke as the cause of brain death was associated with an increased risk of mortality (23% vs 19% at 5 years; HR: 1.17; 95% CI: 1.02-1.35) and allograft failure (HR: 1.30; 95% CI: 1.04-1.63). When donors were older than 40 years, the cause of brain death was not associated with outcomes. ConclusionsAs the cause of donor brain death, stroke had a substantially different effect on recipient and allograft survival depending on donor age. In the case of younger donor ages, stroke was associated with higher recipient mortality and allograft failure than other causes of brain death. The strength of this association decreased with increasing donor age such that the increased hazard was no longer present in donors older than approximately 40 years.

Clinical and subclinical characteristics of brain-dead donors for liver transplantation in Viet Duc University Hospital

Since 2010, 49 cases of liver transplants from brain-dead donors were performed at Viet Duc University Hospital. This study is a descriptive cross-section cohort study with a combined analysis of retrospective and prospective occurrences of a series of cases of liver procurement from brain-dead donors in Viet Duc University Hospital from March 2010 to March 2020. The results of this study showed several features: the average age of the brain-dead donors was 29.8±10.9 (18-69), donors were mostly male (7.17/1, 87.8%), and the main cause of brain death was head trauma. Clinically, 40.8 and 63.3% of the subjects were hypothermic and diagnosed with diabetes insipidus, however, the subjects were all well resuscitated before procurement. Therefore, haemodynamic indices and temperatures were maintained at stable levels and there was no statistically significant difference. In subclinical aspects, haemoglobin and platelet levels decreased significantly but remained within the target criteria during resuscitation while blood sodium levels increased significantly during resuscitation when compared with levels at the time of admission (p&lt;0.001) thus corresponding to diabetes insipidus. In general, 44.90% of donors were within the ideal standard, and in the extended standard group, the highest rate was electrolyte disorders (32.65%). In conclusion, there are many variations in clinical and paraclinical body signs as well as homeostasis in the brain-dead donors. Of these signs, the most prominent were changes in haemodynamics, temperature, urine output, complete blood count, blood clotting, and blood sodium levels. These are all factors that are included in the criteria to consider the selection of a liver donor.

УРОВЕНЬ КОРТИЗОЛА У ПОТЕНЦИАЛЬНЫХ ДОНОРОВ ОРГАНОВ

Currently, the need for the administration of corticosteroids to restore the normal adrenal function in patients with brain death (BD) in order to condition the functional systems before organ harvesting remains unclear. Objectives. To analyze the level of cortisol in potential donors with brain death before harvesting their organs and tissues for transplantation. Material and methods. A prospective pilot study included 60 patients with brain death. The average age of a patient with brain death was 53.5 (48.5; 58.5) years, males - 32 (53.3%) years, females - 28 (46.7%) years. The causes of brain death were: intracerebral hemorrhage - in 30 (50%) patients, traumatic brain injury - in 10 (16.7%) patients, subarachnoid hemorrhage - in 7 (11.7%) patients, cerebral infarction - in 13 (21.6%) patients. The level of cortisol in the blood was determined by the method of radioimmune assay using a set of reagents UP «PP IBC NAS of Belarus» ( Minsk, Republic of Belarus). Results. The cortisol level in patients with BD was 422.8 (216.7; 687.1) nmol/L. The level of cortisol was lower than the reference values in 11 (18.3%) patients with BD, and higher - in 12 (20%) patients. There were no differences between the groups in terms of cortisol level in the following parameters: arterial blood pressure, heart rate, frequency of vasopressors use, dose of vasopressors, time from the patient’s admission to the moment of BD diagnosis, time of observation of a potential donor between two examinations of the council, the number of organs being harvested for transplantation. Conclusions. In potential donors with brain death with low cortisol level, the indices of arterial blood pressure and the doses of injected vasopressors did not statistically significantly differ from those in donors with normal and elevated cortisol level.