Cause Of Brain Death Research Articles

Evaluation of changes in plasma vitamin C levels in brain-dead organ donors

Introduction: Inflammatory events after brain death (BD) generally influence the quality of donated organs and adversely affect the outcome of transplant surgeries. Vitamin C is a natural organic compound with potent antioxidant properties. Changes in serum levels of vitamin C (ascorbic acid) following BD are still unknown. Objectives: This study aimed to assess the changes in serum vitamin C levels in brain dead donors in the time elapsed between BD diagnosis and at once before procurement procedure of donated organs. Patients and Methods: In this experimental study, serum vitamin C levels were measured in 37 brain-dead donors (BDDs) at two time points, primarily on admission (R1) and just before organ procurement (R2). The difference between mean values of R1-R2 was analyzed according to the parameters of brain dead donor’s, which consisted of gender, cause of BD, and type of blood group. Results: A total of 37 BDDs (62.2% male) with a mean age of 26.48±18.1 years were included. Time interval between the two samplings was 40.09±12.10 hours. Overall, there was a statistically significant difference between serum ascorbic acid (AA) levels at admission (R1) and immediately before organ procurement (R2) (P=0.016). However, in terms of the cause of BD and blood type, no significant difference in serum AA at the two-time points was detected (P=0.85 and P=0.79 respectively). Conclusion: Significant differences were observed between serum vitamin C levels in the duration between BD diagnosis and immediately before procurement surgery. Therefore, determining the most effective dose of vitamin C supplementation and the best time to administer it to the patients is highly recommended for future studies.

Changes in Clinical Features and Demographics in Donors After Brain Death Over the Past 20 Years: A Single-Center Experience in the Republic of Korea.

We investigated clinical characteristics and demographics of brain death in patients from a single center in Korea to identify possible changes in organ procurement by comparing early and late periods. Potential donors diagnosed as brain dead and who had provided organ donation consent from May 2000 to May 2020 were considered. Donors were divided into 2 categories: early period (2000-2010) and late period (2011-2020).Demographic data, clinicalrisk factors, cause of death, use ofinotropic and vasoconstrictor agents, laboratory findings, intensive care unit stay data, loss of donors, and number of donated organs were analyzed. Mean age of donors significantly increased in the late period (36.0 ± 12.0 vs 46.0 ± 15.1 years), but there were no significant differences in the proportion of females and the number of pediatric donors (<18 years). The number of donors who smoked decreased (61% vs 41%), but hypertension rate increased significantly in the late period (17.4% vs 31.0%). In the late period, fewer brain dead donors were lost (19.0% vs 7.59%) and use of vasoconstrictor agents was more frequent (25.3% vs 64.5%) than use of inotropic agents (73.1% vs 49.3%). In the late period, heart(19.0% vs 37.3%) and lung (0% vs 18.3%) procurement rates increased and the number of transplanted organs per donorincreased (2.58 ± 1.6 vs 3.14 ± 1.50; P = .016). Causes of death were primarily from head traumas (34.4%), cerebral aneurysms (21.7%), spontaneous intracerebral hemorrhage (21.3%), and asphyxia/hanging (16.3%). Head trauma decreased in the late period (46% vs 29.7%; P = .021) but still constituted the most common cause of death. We found no definite demographic changes in brain dead donors. Donors with cerebrovascular disease increased annually, but trauma was still the most common cause of brain death, with suicides being highly frequent.

Processo diagnóstico de morte encefálica e perfil dos doadores de órgãos e tecidos: Estudo de caso

Objetivo: Analisar o processo diagnóstico de morte encefálica, além de caracterizar o perfil dos doadores de órgãos e tecidos. Métodos: Análise de registros médicos de 203 pacientes com suspeita de morte encefálica acompanhados pela Central de notificação, captação e distribuição de órgãos do norte de Minas Gerais, entre 2013 e 2016. Resultados: Os indivíduos do sexo masculino foram os mais prevalentes (62%), com idade média de 40,4 anos (±16,6), sendo a principal causa de morte encefálica o traumatismo crânio-encefálico (44,5%), seguido pelo acidente vascular cerebral (43,6%). Quanto aos exames complementares, o doppler transcraniano e a arteriografia cerebral foram utilizados na confirmação de morte encefálica em 82,3% e 16,2% dos casos, respectivamente. O percentual de doadores efetivos na população estudada foi de 41% e a taxa média de doadores efetivos por milhão de população entre 2013 e 2016 no norte de Minas Gerais foi de 12,5. Conclusão: O doppler transcraniano apresentou tempo de execução e resolutividade semelhantes ao padrão-ouro. A taxa de efetivação de doações no norte de Minas Gerais foi superior à média estadual e nacional, enquanto a taxa estimada de identificação de potenciais doadores de órgãos foi inferior à média nacional e da maioria dos países desenvolvidos.

Should We Assess the Donor's Lymph Nodes during Lung Procurement? How to Manage When Lymph Node Tuberculosis is Found

Introduction Donor Derived Tuberculosis (TB) after solid organ transplantation is a rare, but deadly, complication, more common in lung transplant (TXP) patients. In brain dead donors the information to rule out latent or active TB is usually not available.The systematic assessment of lymph nodes (LN) is not part of the current techniques described for lung procurement. In fact only in the backtable after lung excision are most LN accessible for evaluation. Case Report We present 2 cases in which during backtable evaluation the LN were considered suspicious and sent for evaluation.Since no guideline addresses this situation we carried on with the transplants. In both cases the report for the LN came back positive in the Ziehl-Neelsen stain and granulomas confirming the presence of TB. Case 1 44 year-old man with COPD. His donor was a 40 year-old man, with cerebral edema post-hyponatremia, with a psychiatric disorder but no other history.The patient underwent a bilateral lung TXP under VA ECMO, he was extubated on day 3 and was discharged 30 days after the TXP. As soon as the diagnosis of the donor was known he started antibacilar treatment (HRZE).His bronchoalveolar lavage, was negative for acid-fastness but the nucleic acid amplification was positive.The patient completed 9 months of therapy. He later developed renal dysfunction, 11 months after the transplant. He now has a follow-up of 3 years 7 months with no evidence of active TB but he did develop chronic rejection and has now been proposed for a re-transplant.Case 2 65 year-old man with COPD. His donor was a 45 year-old man, with liver cirrhosis, whose cause of brain death was a ruptured brain aneurism.The patient underwent a bilateral lung TXP, we was extubated on day 1 and was discharged on the 40th day post TXP. He now has 1 year and 2 months post transplant, he had liver dysfunction after 2 months of HRZE so after normalization of liver function he completed a further 6 months of HR. No evidence of TB has been found. Summary The thorough evaluation of the donors’ lungs should also include their lymph nodes. If the surgeon finds them suspicious, specially in zones with higher incidence of tuberculosis, pathology and microbiology investigation should be made, so that proper treatment can be started before any symptoms occur since the presence of clinically active TB can be deadly, specially in this immunosuppressed group.

Beyin Ölümü Tanısı Alan Hastaların Retrospektif Analizi

Amaç: Bu çalışmada beyin ölümü tanılı hastaların özellikleri, organ bağışı oranları ve uygulanan donör bakımının irdelenmesi amaçlanmıştır. Materyal ve Metot: 2013-2020 yılları arasında hastanemizde beyin ölümü tanısı alan hastaların dosyaları taranarak yaş, cinsiyet, yandaş hastalıkları, yatış tanısı, yatış zamanı, beyin ölümü zamanı, tanı testi yöntemleri, organ bağış oranı, nakledilen organların sayıları, donör bakımında uygulanan tedaviler ve kardiyak arrest süresi gibi veriler kaydedildi. Bulgular: Çalışmamızda 41 hastada beyin ölümü tanısı konulurken 6 (%14,6) hastada organ bağışına onay saptandı. Beyin ölümüne en sık yol açan nedenler travmatik beyin hasarı (n=17) ve serebrovasküler olay (n=17) idi. Hastaların yaş ortalamaları 46,73 ± 23,5 (6-80) iken bunların 6’sı çocuk, 21’i yetişkin ve 14’ü yaşlı hasta idi. Hastaların 12’si (%29,3) kadın, 29’u (%70,7) erkekti. Organ bağışı izni verilmeyen 35 hastada ortalama kardiyak arrest süresi 47,17 ± 38,8 (1-167) saat saptandı. Donör bakımında düşük doz dopamin infüzyonu (4 µg/kg/dk), metilprednizolon infüzyonu ve levotiroksin uygulandığı saptandı. Sonuç: Kadavradan organ transplantasyonu için beyin ölümü tanısının konulması önem arz etmektedir. Nörolojik prognozu kötü hastalar beyin ölümü ve potansiyel donör olmaları açısından yakın takip edilmelidir. Organ bağışını arttırmak için eğitimli ve deneyimli organ nakil koordinatörlerine ihtiyaç vardır. Nakledilen organların sayısını ve kalitesini arttırmak için güncel literatüre uygun donör bakımı protokolleri oluşturulmalıdır.

Discard of organs is the Achilles heel of deceased donor organ transplantation program: a study of ethology and predictors of organ discard from South India

Background: With the significant growth of the deceased donor organ transplantation programs world-wide, the discard of or gans also increased. Our objective was to assess the etiology and predictors of organ discard in Jeevandan-the deceased donor organ transplantation program from South India. Methods: This was a retrospective chart analysis. Univariate and multivariate logistic regression analysis was used to predict the indicators of organ discard. Results: The kidney discard rate and liver discard rate was 19.27% and 7.68%, respectively. The main reason for kidney discard was marginal donor kidney (61.23%) followed by chronic kidney disease in the donor (15.94%). For liver discard, the main reason was cirrhosis of the liver (34.54%) followed by non-alcoholic fatty liver disease (20%). The risk factors for kidney discards were higher age, male gender, intracerebral hemorrhage as a cause of brain death, long-standing diabetes, hypertension, and elevated terminal creatinine. Protective factors against kidney discard were higher serum proteins and higher sodium. Risk factors for liv er discards were history of alcohol abuse, higher bilirubin, higher alanine aminotransferase, and acute kidney injury. Higher plate let count is a novel protective factor identified. Conclusions: We assessed the etiology for discard of kidneys and livers in a deceased donor organ transplant program. The fac tors that predict the discard and protective factors against discard were identified.

Usefulness of a preoperative inflammatory marker as a predictor of asymptomatic acute rejection after lung transplantation: a Japanese single-institution study.

BackgroundSurveillance bronchoscopy (SB) is performed as routine follow-up after lung transplantation (LTx), primarily for the early detection of clinically asymptomatic acute rejection (AR). To identify appropriate candidates for SB over a long period, we explored risk factors of asymptomatic AR after LTx.MethodThis study is a single-center and retrospective cohort study. Forty-five patients underwent cadaveric LTx between 2000 and 2016 in our institution. All enrolled patients had at least three months of follow-up. SB is scheduled at 1, 2, 3, 6, and 12 months after LTx routinely and annually thereafter until 5 years after LTx. A histological assessment for AR was performed according to the International Society for Heart and Lung Transplantation (ISHLT) criteria. The analysis of potential risk factors for AR was performed using a chi-square test and logistic regression analysis.ResultsThe median period of follow-up after LTx for the entire cohort was 64 months. Asymptomatic AR (grade A1-A3) was detected in 22 patients, 14 of whom showed severe AR (worse than grade A2). The percentage of patients with AR was 5–24% at each time point, and 15% of patients still showed severe AR (A2 and A3) at 24 months after LTx. Potential risk factors included recipient factors (diagnosis, age, gender, BMI), donor factors (age, gender, smoking history, cause of brain death), HLA mismatch, operation-related factors, neutrophil-to-leucocyte ratio (NLR), platelet-to-leucocyte ratio (PLR), and other scores. Patients with a higher NLR showed a higher incidence of AR after LTx than others during follow-up (P=0.01).ConclusionsAn increased perioperative NLR was significantly associated with a higher odds ratio of AR during follow-up. Patients with a high NLR seem to be good candidates for long-term SB.

Risk for Delayed Graft Function in Deceased Donor Renal Transplant Patients: A Single-Center Experience From North India

ObjectivesDelayed graft function (DGF) in renal allograft transplantation refers to the need for dialysis in the first week after renal transplantation. This study analyzed the causes of DGF in deceased donor transplantation. MethodsData from January 2018 to July 2019 was reviewed with regard to donor and recipient characteristics such as demographics, biochemical parameters, organ dysfunction, and preterminal management. The recipients were divided into 2 groups: group I: patients without DGF and group II: patients with DGF. ResultsKidneys were retrieved from 49 deceased donors (male:female = 41:8) and transplanted to 95 recipients (male:female = 60:35). Mean age of the donors and recipients was 35.34 ± 18.2 and 40.72 ± 13.30 years, respectively. The most common cause of brain death was central nervous system trauma (45 out of 49, 91%). In total, 20/95 (21%) recipients had DGF. Twelve recipients had received kidneys from donors who had circulatory arrest. Two patients were re-explored on postoperative day 1 for bleeding from renal artery anastomosis. The mean age in group I and group II was 28.65 ± 10.2 and 37.38 ± 12.28 years, respectively. The mean cold ischemia time in group I and group II was 398.73 ± 187.19 and 333.24 ± 115.49 minutes, respectively. The mean hospital stay of donor before donation in group I and group II was 4.34 ± 1.27 and 6 ± 2.95 days, respectively. The terminal donor creatinine in group I and group II was 0.88 ± 0.47 and 2.33 ± 1.73 mg/dL, respectively. ConclusionDGF in deceased donor transplantation may be attributed to donation after circulatory death, prolonged donor hospital stay, high donor leukocyte count, and high terminal creatinine.

Reasons for Low Utilization of Pancreas for Transplantation From Deceased Donors: Analysis of Data From a Single Center in India

ObjectivesAlthough pancreas transplants were started at our center in 2014, the number of pancreases procured have remained low. This report presents an audit of donors over the past 18 months with the aim to identify factors preventing pancreas utilization. MethodsThis was a retrospective study. All deceased donors from January 2018 to July 2019 were included in this study. The medical records of deceased donors were reviewed with regard to donor characteristics such as demographics, biochemical parameters, and preterminal management. ResultsOrgans were retrieved from 49 deceased donors over the duration of the study. Mean age of the donors was 35.34 ± 18.2 years (11 months to 72 years). Most donors were men (M:F 41:8). In total, 45/49 (92%) donors had central nervous system trauma as a cause of brain death. Out of 49, multiple abdominal organs were retrieved from 21 donors (42.8%), whereas kidneys alone were retrieved from the rest. Pancreases were retrieved from 8 donors (16.3%). Pancreases were rejected in 21 donors (42.8%) because of age limit criteria. Other reasons for refusal included donor sepsis (n = 12, 24.5%), severe hemodynamic instability (n = 5, 10.2%), donation after cardiac death (DCD) (n = 2, 4.1%), and ischemic hepatitis (n = 7, 14.3%) while 3 (6.1%) donations happened while awaiting license renewal. A suitable recipient was not available for 1 donor (2.0%). ConclusionPancreas retrieval rates remain low because of donor-related factors. Expansion of age limits and better donor management could improve pancreas transplant activity.

Organ Donation and Primary Central Nervous System Tumors

Primary central nervous system tumors can be the cause of brain death. Not all of them contraindicate the donation of organs and tissues for transplant. A survey of cases was carried out in our country in which it was observed that the number of brain deaths caused by primary tumors was low, of the order of 2%, with an ẋ (media) of 3 by year, which would increase the potential for donation. Medical records, an anatomopathologic study, and a detailed physical examination will be fundamental when applying the donor selection criteria. Nuclear magnetic resonance in expert hands has a sensitivity of 96% to catalog the benignity or malignancy of this type of tumors.

Anesthetic Management of Brain-dead Adult and Pediatric Organ Donors: The Harborview Medical Center Experience.

The exposure of anesthesiologists to organ recovery procedures and the anesthetic technique used during organ recovery has not been systematically studied in the United States. A retrospective cohort study was conducted on all adult and pediatric patients who were declared brain dead between January 1, 2008, and June 30, 2019, and who progressed to organ donation at Harborview Medical Center. We describe the frequency of directing anesthetic care by attending anesthesiologists, anesthetic technique, and donor management targets during organ recovery. In a cohort of 327 patients (286 adults and 41 children), the most common cause of brain death was traumatic brain injury (51.1%). Kidneys (94.4%) and liver (87.4%) were the most common organs recovered. On average, each year, an attending anesthesiologist cared for 1 (range: 1 to 7) brain-dead donor during organ retrieval. The average anesthetic time was 127±53.5 (mean±SD) minutes. Overall, 90% of patients received a neuromuscular blocker, 63.3% an inhaled anesthetic, and 33.9% an opioid. Donor management targets were achieved as follows: mean arterial pressure ≥70 mm Hg (93%), normothermia (96%), normoglycemia (84%), urine output >1 to 3 mL/kg/h (61%), and lung-protective ventilation (58%). During organ recovery from brain-dead organ donors, anesthesiologists commonly administer neuromuscular blockers, inhaled anesthetics, and opioids, and strive to achieve donor management targets. While infrequently being exposed to these cases, it is expected that all anesthesiologists be cognizant of the physiological perturbations in brain-dead donors and achieve physiological targets to preserve end-organ function. These findings warrant further examination in a larger multi-institutional cohort.

Organ donation from brain-dead pediatric donors in Korea: A5-year data analysis (2013-2017).

In Korea, 2-4% of brain-dead organ donations are from donors <16years of age. We aimed to identify the current status of and challenges in pediatric organ donation from brain-dead donors in Korea. We performed a retrospective analysis using data from KONOS between January 1, 2013, and December 31, 2017. Our research identified 107 pediatric donors aged <16years, representing 4.4% of all donors in Korea between 2013 and 2017. The consent rate was higher in PDs than in adult donors (47.0% vs 44.9%). The most common cause of brain death in PDs was hypoxia (28.0%), followed by brain tumor and trauma, whereas that in ADs was brain hemorrhage/stroke (42.4%), followed by trauma and hypoxia (P<.001). In both groups, the kidney (PDs vs ADs: 75.7% vs 88.5%), liver (58.9% vs 46.2%), and heart (32.7% vs 29.7%) were the organs most commonly transplanted. However, pancreatic (PDs vs ADs: 30.0% vs 11.7%, P<.001) and small bowel transplantations (4.7% vs 0.2%, P<.001) were more common in PDs, whereas lung (7.5% vs 14.5%, P=.046) and corneal transplantations (14.0% vs 36.2%) were more common in ADs. Only a small proportion of organ donations in Korea are from PDs, but this rate has been maintained. Given the current status of brain-dead pediatric organ donation, a more active approach is required to bring about improvement.

Factors affecting organ donation rate during devastating brain injuries: a 6-year data analysis

Objectives The discrepancy between organ donation rate and the number of patients waiting transplantation has been a common problem in Turkey. Intracerebral hemorrhage (ICH), traumatic brain injury (TBI), anoxic encephalopathy, stroke, and brain tumors comprise the majority of the causes of brain death. This study thus aimed is to analyze potential brain deaths and factors associated with organ donation among such patients. Material and methods Medical records of 629 intensive care unit (ICU) patients with potentially devastating cerebral lesions from 01/2013 to 12/2018 were retrospectively analyzed. Clinical characteristics and the prevalence of consent for organ donation were then assessed. Results Although possible brain death was considered in 102 patients, 21 (18%) died before diagnostic tests could be performed. Accordingly, the 81 potential organ donors had a donor conversion rate (DCR) of 30%. Causes of non-organ retrieval among potential donors included refusal of consent by relatives (89.5%), indecision of the family regarding donation or no relatives present (7%), and medical unsuitability for donation (3.5%). Conclusions Our findings showed that refusal by the family was the most common reason for failure of deceased organ donations. To maximize the number of procured organs, transplant communities need to focus on increasing awareness regarding brain death and organ donation and establish strategies to increase consent obtained from the families.

The Number of Patients Diagnosed with Brain Death and Organ Donation Rates at the Başkent University Konya Hospital: 6-Year Experience

Kidney transplant started at Başkent University Konya Hospital in July 2016. In this study, we compared the causes of brain death and the organ donation rates in our center between 2013 and 2016 versus between 2016 and 2019. Patient files and records were analyzed retrospectively. Age, biologic sex, cause of brain death, and organ donation rates of patients diagnosed with brain death were examined and compared. The number of patients who were diagnosed with brain death and became deceased donors at our center increased 4-fold during the period from 2016 to 2019 compared with that shown from 2013 to 2016. In addition, organ donation rates increased to 71.4%, which is much higher than the average in Turkey (24%-28%). Between 2013 and 2016, trauma was the leading cause of brain death (42.8%), whereas between 2016 and 2019 cerebral hemorrhages rose to first place with a rate of 89.3%. In 2018 and 2019, there were 199 and 62 brain deaths, respectively, reported in our organ donation coordination region with an approximate organ donation rate of 25%. In our center, 12 patients were diagnosed with brain death in 2018 and 8 of these patients (66.7%) became donors; 6 brain deaths were diagnosed in 2019, and 4 patients (66.7%) became donors. Since we started kidney transplant at our center in 2016, the number of patients diagnosed with brain death has increased significantly. Establishing a healthy communication with relatives of patients and having a dedicated organ transplant center are important reasons for our much higher organ donation rates compared with the general rate in Turkey. A healthy communication is the most effective way to establish trust with next-of-kin and the general public.

Donor Heart Utilization in Korea.

Background and ObjectivesDonor heart utilization patterns in Korea are not well known. We aimed to analyze the current utilization rate of donor heart and to evaluate the reason for non-utilization in Korea.MethodsBrain death donors were identified from the Korean Network for Organ Sharing registry from November 2009 to December 2019. Baseline characteristics and heart transplant related parameters were compared between transplanted and discarded donor hearts.ResultsAmong 4,401 donors, 1,383 (31.4%) hearts were utilized. Hearts from younger, male donors without history of hypertension or diabetes mellitus were utilized more frequently. The most common blood type in the transplanted group was O, while blood type A was the most common blood type in the discarded group. The ejection fraction in the discarded group were significantly lower (57.0 ± 13.5% vs. 61.7 ± 7.0%, p<0.001). Reasons for non-utilization were as follows: medical condition (34.4%), old age (31.8%), refused by all candidates (22.5%), refused to donate (11.0%), and others (0.2%). The most common cause of brain death was cerebrovascular disease in both the transplanted and discarded groups, but the incidence was significantly higher in the discarded group (46.8% vs. 37.5%, p<0.001). In multivariate analysis, old age, small body surface area, rapid heart rate, blood type other than O, abnormal echocardiography findings were independent predictors for non-utilization.ConclusionsAverage donor heart utilization rate was 31.4% and it improved to 42.9% in 2019. However, substantial numbers of donor hearts are still discarded. A strategic approach to improve donor heart utilization is necessary.

Organ donation in Korea in 2018 and an introduction of the Korea national organ donation system.

A total of 1,503 solid organs were procured from 449 deceased donors in 2018. Although the number of donors was down by 12.8% from the previous year (8.7 per million population), the number of organs procured per donor increased from 3.29 in 2017 to 3.35 in 2018. While the causes of brain death by cerebrovascular diseases and head trauma from traffic accidents have declined, brain damage from hypoxia has increased slightly. The most prominent change in the decline of organ donations was a decrease in family consent (36.5% in 2018 vs. 42.9% in 2017). The disagreement over organ donations by other family members even extended beyond the next of kin, and the restriction of organ donations in connection with the suspension of end-of-life care partly affected the consent rate, making this a controversial social issue. An accurate analysis regarding the factors causing the decline of familial consent rates is required, and related organizations along with the government should make a unified concerted effort to resolve this issue. To help achieve this goal, this manuscript describes the transplantation process and briefly explains the Korean domestic organ donation system.

Evaluation of Brain Death in Children: A Single Center Experience

Introduction: Brain death is defined as a status of apnea, coma and the absence of brainstem reflexes, in addition to the presence of electrocerebral silence (ECS) on an electroencephalography (EEG). Trauma and anoxic encephalopathy are the most common causes of brain death in children, with incidences of brain death reported to vary between 0.65–1.2 percent. A diagnosis of brain death can be made based on a detailed anamnesis, physical examination findings and supportive test results. When pediatric patients are being evaluated by EEG, they should also be assessed in terms of medications, metabolic encephalopathy, hypothermia, electrolyte imbalance and acid-base imbalance. Patients and Methods: The present study included patients who suffered brain death during hospitalization in the pediatric intensive care unit of Inonu University Turgut Ozal Medical Center between 2010 and 2017. The medical files of the patients were reviewed retrospectively. All patients included in the study underwent an EEG and an apnea test was performed on all patients. The cerebral blood flow (CBF) measurement was obtained through a Computerized Tomography Angiography (CTA), and all patients underwent a Magnetic Resonance Angiography (MRA) and a Transcranial Doppler Ultrasonography (TCD). Results: Of the 20 patients included in the study, nine (45%) were female and 11 (55%) were male, with a mean age of 8.47±5.73 years. Of the total, seven patients presented with fulminant hepatitis, three with trauma, three with sepsis, two with drowning, two with cerebrovaskuler disease (CVD), and one patient each with lymphoma, suicide and electric shock. The families of only two (10%) patients donated the organs of the deceased. Of the 20 patients, four were Syrian, and of which were being monitored with the diagnosis of liver failure. An apnea test was positive in all patients, and in all patients, the EEG findings supported brain death. Imaging methods were carried out to demonstrate the absence of CBF flow in 11 (55%) patients, and diabetes insipidus (DI) developed in nine (45%) of the patients with brain death. Conclusion: In conclusion, a multidisciplinary approach is required for the diagnosis of brain death. An evaluation of laboratory findings and EEG results together with the findings of a physical examination is important, particularly in centers like our clinics where more than 50 pediatric transplantations are carried out each year. The development of hypernatremia in patients with DI is now an important parameter in the loss of brain function.

Analysis of factors involved in brain-death donor processing for face transplantation in Korea: How much time is available from brain death to transplantation?

BackgroundFace transplantation has naturally evolved from reconstructive procedures. However, few institutions perform face transplantations, because it is time-consuming and it is necessary to justify non-vital organ transplantation. We investigated the process of organ donation from brain-dead patients and the possibility of incorporating face transplantation into the donation process.MethodsA retrospective review was performed of 1,074 brain-dead patients from January 2015 to December 2016 in Korea. We analyzed the time intervals from admission to brain death decisions (first, second, and final), the causes of brain death, and the state of the transplanted organs.ResultsThe patient base (n=1,074) was composed of 747 males and 327 females. The average period between admission to the first brain death decision was 8.5 days (±15.3). The average time intervals between the first brain death decision and medical confirmation using electroencephalography and between the first brain death decision and the final determination of brain death were 16 hours 58 minutes (±14 hours 50 minutes) and 22 hours 57 minutes (±16 hours 16 minutes), respectively. The most common cause of brain death was cerebral hemorrhage/stroke (42.3%), followed by hypoxia (30.1%), and head trauma (25.2%).ConclusionsWhen face transplantation is performed, the transplantation team has 22 hours 57 minutes on average to prepare after the first brain death decision. The cause of brain death was head trauma in approximately one-fourth of cases. Although head trauma does not always imply facial trauma, surgeons should be aware that the facial tissue may be compromised in such cases.

Brain Deaths and Donors in an Education and Research Hospital

BackgroundWe aimed to define the causes of brain death (BD), criteria, and tests used for diagnosis, rates of family consent, and rates of organ donation in intensive care units (ICUs) of an education and research hospital. MethodsThe data of patients with BD diagnosis in 7 years in our hospital was collected from an electronic database and archives retrospectively consisting of the demographic data, the causes of BD, criteria, and the tests used for diagnosis, family consent, and organ donation rates. ResultsA total of 210 patients with BD diagnosis were enrolled in the study. There was a decline in number of patients with BD diagnosis between 2012 (54.76%) and 2018 (17.64%) in the neurology and neurosurgery ICU, while it increased from 35.71% in 2012 to 70.6% in 2018 in the general ICU. The most common cause of hospitalization for BD was spontaneous intracranial hemorrhage (43.8%). A total of 47.6% of brain-dead patients who did not qualify for organ donation were resuscitated unnecessarily after cardiac death. In 2012, diagnosis was always supported by ancillary tests, while in 2018, a total of 35.29% of the patients were diagnosed solely by clinical examination; 23.8% of patients’ families had given consent for organ donation, and 19.53% of 210 patients became donors. ConclusionPhysicians should be aware that patients with poor neurologic outcome can be candidates of BD donation, and careful examination and rapid diagnosis is crucial. All segments of society and the health care professionals should be informed and updated about organ donation and BD regularly to raise the numbers of organ donation.

Profile of Effective Donors for Heart Transplantation: Experience of a Brazilian Center

BackgroundBrazil’s transplant network is a consolidated, worldwide-recognized program, with about 96% of heart transplantations (HTs) financed by its Unified Health System. It is known that the number of HTs has risen in the past few years, but it still does not meet the demand. This study aims to characterize the profile of the heart donors of a Brazilian center and ascertain the factors contributing to the increase in number of HTs. Materials and methodsThis is a cross-sectional and analytical study, developed between 2012 and 2018 at a Brazilian transplant center. ResultsThere were 210 donations for HT in this period. The median age of donors in years (range) was 33 (24–40), and the donors were 15.5 years younger than the recipients (P value < .001). One hundred forty-two donors (67.6%) were male, 98 (46.7%) were mullato, and 115 (54.8%) had cranioencephalic trauma as the cause of brain death. The distance from the transplant center to the organ procurement area was short in 183 (87.1%) cases, enabling a allograft ischemic time with a median of 125 minutes. There was a relevant association between donor age and cause of brain death (P < .001), sex and cause of brain death (P < .001), and organ procurement area and allograft ischemic time (P < .001). Hospitals that provide urgent and emergency care served as sources for a larger number of organ donations. ConclusionsThis study concluded that the profile of most donors for HT include young adult mullato men who were victims of cranioencephalic trauma. In addition, these donors had few comorbidities and a median age of 33 years.