Brain Death Management Research Articles

Consent to testing for brain death

Canada has recently published a new Clinical Practice Guideline on the diagnosis and management of brain death. It states that consent is not necessary to carry out the interventions required...

156 Activation of the complement system early on during brain death management

156 Activation of the complement system early on during brain death management

Brain death diagnosis and management in the COVID-19 pandemic

Purpose: This present study aimed to share experiences in the diagnosis and management of brain death (BD) and cadaveric donation cases, detected in a research hospital during the COVID-19 pandemic.
 Materials and Methods: BD cases diagnosed between 15/03/2020-15/05/2021 in our intensive care units (ICU) were retrospectively evaluated. Patients’ demographic characteristics, primary diagnoses, ICU admission time, and length of hospital stay were analyzed. Clinical suspicion, diagnosis, declaration, and donation or cardiac arrest times and supplementary tests to support the clinical judgment performed were also evaluated. 
 Results: 37 cases, were included in the study. Intracranial hemorrhage was the most common (54.1%) diagnosis in ICU admissions. Apnea tests could be performed only in 27 patients (73%). Cerebral CT-angiography was used as a supplementarytary test in 27 (73%) cases. Family consent for organ donation was obtained from 10 patients (27%), and 70% (n= 7) of them became donors. The time between ICU admission and BD diagnosis time was 114±92.8 (11-360) hours, the time between clinical suspicion and diagnosis was 32±15.1 (4-78) hours, the time between diagnosis and cardiac arrest of non-donors was 24±15.2 (5-72) hours, and the time between diagnosis and donation was 23±7.6 (15-35) hours.
 Conclusion: Occupancy in ICUs due to COVID-19 has reduced the admission of patients who may be donors to ICUs, and there has been a decrease in the number of BD detection, family approval, and organ donation in our hospital.

Incidence, Risk Factors, and Outcomes of Delayed Graft Function in Deceased Donor Kidney Transplantation

ObjectiveDelayed graft function (DGF) is the most significant complication of a cadaveric kidney transplant. We aim to evaluate the predictable risk factors of DGF and its effects on the recipient and graft survival. MethodFrom January 2014 to December 2017, the medical records from 62 patients who received a kidney transplant from a deceased donor were retrospectively reviewed. We classified recipients into 2 groups. The risk factors of DGF associated with donor, recipient, and transplant procedures were analyzed. DGF's effects on the graft survival were examined. ResultsThe incidence rate of DGF was 43.5%. Older ages of donors, marginal donors (n = 15), length of stay in the intensive care unit, and terminal serum creatinine concentrations were observed to be statistically significant compared to recipients without DGF (P < .5). The ratio of serum creatinine concentrations before/after brain death was found to be significant for the groups with DGF (P < .05). Cold ischemia time (CIT) was examined as the most significant risk factor on DGF (P = .001). One-year patient survival rates were 94.5% and 92.3%, and graft survival rates were 92.1% and 87.5% (P = .05), respectively, for the groups with and without DGF. ConclusionOlder ages of donors, occurrence of acute kidney injury, its grade just before harvesting, and long duration of CIT are the most important risk factors for DGF. Brain death management, shortening the time between brain death and harvesting, and also shortening the duration of CIT can decrease the risk of DGF and can increase the graft survival.

Assess the Knowledge on Nursing Management of Brain Death among Nursing Students AIMS, Kochi, Kerala

Assess the Knowledge on Nursing Management of Brain Death among Nursing Students AIMS, Kochi, Kerala

Intercultural competence. Management of foreignness in intensive care medicine

Living in a multicultural society is characterized by different attitudes caused by a variety of religions and cultures. In intensive care medicine such a variety of cultural aspects with respect to pain, shame, bodiliness, dying and death is of importance in this scenario. To assess the importance of cultural and religious attitudes in the face of foreignness in intensive care medicine and nursing. Notification of misunderstandings and misinterpretations in communication and actions. An analysis of the scientific literature was carried out and typical intercultural conflict burden situations regarding the management of brain death, organ donation and end of life decisions are depicted. Specific attitudes are found in various religions or cultures regarding the change of a therapeutic target, the value of the patient's living will and the organization of rituals for dying. Intercultural conflicts are mostly due to misunderstandings, assessment differences, discrimination and differences in values. Intercultural competence is crucial in intensive care medicine and includes knowledge of social and cultural influences of different attitudes on health and illness, the abstraction from own attitudes and the acceptance of other or foreign attitudes.

Current Innovations in the Diagnosis and Management of Brain Death and Donation After Cardiac Death (426) (Advanced)

Current Innovations in the Diagnosis and Management of Brain Death and Donation After Cardiac Death (426) (Advanced)

Modulación hormonal del donante de órganos. Utilidad de los esteroides

Recently, the work group made up of the National Transplant Organization (Organización Nacional de Trasplantes, ONT), Spanish Society of Intensive, Critical Medicine and Coronary Units (Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias, SEMICYUC) and other Scientific Societies have recommended using 15 mg/kg of methyl prednisolone during the management of lung donors after brain death. This recommendation is based on descriptive and retrospective studies. However, the review of different experimental and clinical studies also suggests a potential benefit of using steroids in either thoracic or abdominal organ donors during management strategies. In brain death management, early steroid administration may decrease cytokine production and also may prevent alterations induced by proinflammatoy mediators, stabilize cell membranes, reduce expression of cell surface adhesion molecules and avoid lipid peroxidation after the ischemic period. This could be beneficial in increasing number and quality of organs harvested and in decreasing rejection episodes after transplant. It would be very recommendable to carry out prospective and comparative studies to demonstrate these potential utilities. Meanwhile and knowing the deleterious effects of inflammatory activity arising during and after brain death, we recommend using 15 mg/kg of methyl prednisolone in the organ donor management, as soon as possible. The potential benefit of its immunomodulation effects, its low cost and the absence of major side effects can justify this recommendation.

Diagnosis and management of brain death in children

Summary This article reviews the concept of death and, specifically, the definitions of brain death, particularly as applied to children. The development of definitions for the concept of brain death has been driven by the technological advances of the last century in intensive care, long-term ventilatory support and transplantation medicine. Brain death is not uncommon in children. Attention to the management of children who are brain dead, with timely diagnosis and intervention where appropriate can improve the condition of organs for transplantation. Full and careful discussion of the situation with the parents may enable the family to better accept the death of their child.

Meeting the needs of the family: the role of the specialist nurse in the management of brain death.

Clinical nurse specialist roles have existed in the USA for many years, yet here in the UK such roles are a relatively new concept for nurses and the profession of nursing. In the UK clinical nurse specialists have worked primarily in outpatient settings, however, the role is rapidly developing in primary care and specialized care settings. One specific dimension of the clinical nurse specialist role in critical care relates to the needs of the family when brain-stem death is suspected. This concept of death--brain death--is very difficult for most people to comprehend as it challenges all our previous beliefs concerning death and dying. During this traumatic time nurses and other health care professionals face the daunting task of supporting the family through this enforced emotional crisis as they attempt to come to terms with the diagnosis of clinical brain death. To enable families to understand brain death and the implications and outcomes of such a diagnosis it is vital they receive information, support and guidance from experienced health care personnel. The following account is a discussion of the key role of the specialist nurse in relation to meeting the needs of the families of brain-stem dead patients. This review seeks to highlight the clear dimensions of the clinical nurse specialist role within a critical care setting. It relates specifically to meeting the needs of families who have experienced clinical brain death in an immediate family member. It suggests that the infinite value of the role must be acknowledged and utilized to ensure the provision of holistic care for patients and families at this traumatic time.

Management of Brain Death and Organ Transplantation

Management of Brain Death and Organ Transplantation

The diagnosis and management of brain death

When death takes place, the body, as a whole, dies first, the death of the tissues not occurring until after a considerable interval. The definition of death itself, in the most familiar of its several meanings, can be valid only with reference to some stated ‘level’ of biological organisation. A society will die before its individual members, an individual before his cells, and a cell before its ferments have stopped working. But legally, I suppose, a man is dead when he has undergone irreversible changes of a type that make it impossible for him to seek to litigate.

A BRAIN-DEATH PROTOCOL

A protocol for the management of patients thought to have suffered brain death includes a list of questions to aid the diagnosis of brain death and guidelines for dealing with relatives competently and compassionately. If the relatives give permission for the removal of organs for transplantation, the protocol enables the procedure to be carried out quickly. In the two years from July, 1977, 22 patients in one intensive-therapy unit suffered brain death, and kidneys were donated from 11 of these patients and eyes from 4. The management of brain death and the provision of organs for transplantation are best dealt with by one department in a hospital.

Diagnosis and management of brain death.

Finland was the first country in which brain death was legally accepted. Since 1975, 37 cases of brain death had been recorded in a university hospital in Finland, and these were reviewed. The cause for brain death was intracranial bleeding in 32 cases, other cerebrovascular disorder in two, and intracranial neoplasm in three. In 21 brain death was diagnosed clinically. In 16 cases confirmatory investigations (electroencephalography, cerebral angiography) were needed. After brain death had been established artificial support was withdrawn in 15 patients and organ transplantation was carried out in 10. In 12 patients, however, diagnosis of brain death did not influence management, though the heart stopped beating on average 25 hours after diagnosis. The Finnish criteria for brain death seem to be reliable and suitable for routine use.