Brain Death And Donor Management During 13 Years in AkdenizUniversty
Özlem Çaki̇n1, Ayça Gümüş1, Murat Yilmaz1, Meli̇ke Cengi̇z1, Ni̇lgün Keçeci̇oğlu2, Atilla Ramazanoğlu1
1Anesthesia and Reanimation,Akdeniz University,Antalya,Turkey
2Akdeniz Universty Hospital, Organ Transplantation Center
BACKGROUND AND AIM: The diagnosis and incidence of brain death and donor management were investigated in Akdeniz University ICU.
MATERIAL AND METHODS: Records of 411 brain death patients admitted to ICU between 2003 and 2016 were evaluated. However, 211 patient’s records were found eligible to be included in the study.
RESULTS AND DISCUSSION: Mean age was 37, 68(2-80) and 141(58%) of the patients were male. Primary pathology leading to brain death was intracranial hemorrhagea in 116 (77,9%) patients. Other causes were tumors (7%), infarcts (3,7%), meningoencephalitis (3,2%) and others. Clinical examinations of 42 (19,7%) patients were compatible with brain death at the time of ICU admission. Mean GCS at emergency room and ICU admission were 7 and 5, respectively. Apnea testing could not be performed in 14 (6,5) patients because of hemodynamic instability or hypoxemia. Brain death diagnosis were confirmed with SPECT (32,8%), Transcranial Doppler USG (26,5%), electroencephalography (%24,6). More than one confirmatory test was used in 26% of patients. Spinal reflexes were observed in 27 (12,6%) patients and two patients had Lazarus sign. Sympathic storm and diabetes insipidus were determined in 33,3% and 57,2% patients. Vasoactive drug infusion was used in 147 (33,8%) patients for improving hemodynamic variables. Organ donation was performed in 139 (33,8%) brain dead patients among 411 patients diagnosed as brain death in 13 years.
CONCLUSION(S): Brain dead patients are potential organ donors and should be identified and treated immediately.Unsuccessful apnea testing incidence and reasons for brain death was in accordance with other studies. Sympathic storm was less frequent than other studies (33% vs 63%). Different cultures and nations have various perspectives and regulations in terms of brain death and organ donation which may hamper rapid diagnosis of the potential donors. However, ICU clinicians should be sophisticated and careful about determining brain death and providing donor care
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