Brain death organ donation potential and life support therapy limitation in neurocritical patients

Abstract

Objective: To analyze the profile, incidence of life support therapy limitation (LSTL) and donation potential in neurocritical patients.

Study design: A multicenter prospective study was carried out.

Setting: Nine hospitals authorized for organ harvesting for transplantation.

Patients: All patients consecutively admitted to the hospital with GCS < 8 during a 6-month period were followed-up until discharge or day 30 of hospital stay.

Study variables: Demographic data, cause of coma, clinical status upon admission and outcome were analyzed. LSTL, brain death (BD) and organ donation incidence were recorded.

Results: A total of 549 patients were included, with a mean age of 59.0 ± 14.5 years. The cause of coma was cerebral hemorrhage in 27.0% of the cases.LSTL was applied in 176 patients (32.1%). In 78 cases LSTL consisted of avoiding ICU admission. Age, the presence of contraindications, and specific causes of coma were associated to LSTL. A total of 58.1% of the patients died (n=319). One-hundred and thirty-three developed BD (24.2%), and 56.4% of these became organ donors (n=75). The presence of edema and mid-line shift on the CT scan, and transplant coordinator evaluation were associated to BD. LSTL was associated to a no-BD outcome. Early LSTL (first 4 days) was applied in 9 patients under 80 years of age, with no medical contraindications for donation and a GCS ≤ 4 who finally died in asystole.

Conclusions: LSTL is a frequent practice in neurocritical patients. In almost one-half of the cases, LSTL consisted of avoiding admission to the ICU, and on several occasions the donation potential was not evaluated by the transplant coordinator.

Keywords: Brain Death; Donación de órganos; Life Support Therapy Limitation; Limitación tratamiento de soporte vital; Muerte Encefálica; Organ Donation; Potencialidad; Potential.