Neurointensivists' opinions about death by neurological criteria and organ donation

Abstract

Introduction: Neurointensivists are at the front line of treatment of patients who progress to death by neurological criteria (DNC). Although some of these patients will become organ donors, there has not been a systematic evaluation of the opinions and resources available to neurointensivists in regard to these important issues.

Methods: We conducted a survey of neurointensivists regarding controversial issues in the declaration of DNC, procedures for discussing death and approaching donor families, and participation in donation after cardiac death (DCD).

Results: The majority of centers described by the respondents had all five most commonly accepted ancillary tests to determine DNC (61%). Radionuclide blood flow studies are the most frequently reported test used (64%). Younger physicians are more likely to use trans-cranial Doppler exams (TCD) than their older counterparts (41% versus 28%, p<0.001). Discussions about DNC with the family are most often presided by the attending physician, and donation requests are most commonly initiated by organ procurement organization (OPO) representatives, but there is significant variation from center to center. Nine out of 10 physicians in our survey reported that they are likely to participate in DCD.

Conclusion: Despite this enthusiasm, there is no clear consensus on many of the issues surrounding DCD, including how long after cardiac cessation recovery should begin. We believe that this study will serve as a springboard for more discussion about the diagnosis of DNC, the role of physicians in organ requests and donor management, and the procurement of organs through DCD.