Assessing Outcomes of Patients Subject to Intensive Care to Facilitate Organ Donation: A Spanish Multicenter Prospective Study

Overview

Journal Transpl Int

Specialty General Surgery

Date 2024 Apr 29

PMID 38681973

Authors

Alicia Perez-Blanco

Maria Acevedo

Maria Padilla

Aroa Gomez

Luis Zapata

Maria Barber

Adolfo Martinez

Veronica Calleja

Maria C Rivero

Esperanza Fernandez

Julio Velasco

Eva M Flores

Brigida Quindos

Sergio T Rodriguez

Beatriz Virgos

Juan C Robles

Agustin C Nebra

Jose Moya

Josep Trenado

Nieves Garcia

Ana Vallejo

Eugenio Herrero

Alvaro Garcia

Maria L Rodriguez

Fernando Garcia

Ramon Lara

Lucas Lage

Francisco J Gil

Francisco J Guerrero

Angela Meilan

Nayade Del Prado

Cristina Fernandez

Elisabeth Coll

Beatriz Dominguez-Gil

Affiliations

Soon will be listed here.

Abstract

Intensive Care to facilitate Organ Donation (ICOD) consists of the initiation or continuation of intensive care measures in patients with a devastating brain injury (DBI) in whom curative treatment is deemed futile and death by neurological criteria (DNC) is foreseen, to incorporate organ donation into their end-of-life plans. In this study we evaluate the outcomes of patients subject to ICOD and identify radiological and clinical factors associated with progression to DNC. In this first prospective multicenter study we tested by multivariate regression the association of clinical and radiological severity features with progression to DNC. Of the 194 patients, 144 (74.2%) patients fulfilled DNC after a median of 25 h (95% IQR: 17-44) from ICOD onset. Two patients (1%) shifted from ICOD to curative treatment, both were alive at discharge. Factors associated with progression to DNC included: age below 70 years, clinical score consistent with severe brain injury, instability, intracranial hemorrhage, midline shift ≥5 mm and certain types of brain herniation. Overall 151 (77.8%) patients progressed to organ donation. Based on these results, we conclude that ICOD is a beneficial and efficient practice that can contribute to the pool of deceased donors.

References

Rosen D, Loch Macdonald R . Subarachnoid hemorrhage grading scales: a systematic review. Neurocrit Care. 2005; 2(2):110-8. DOI: 10.1385/NCC:2:2:110. View

Dominguez-Gil B, Coll E, Elizalde J, Herrero J, Pont T, Quindos B . Expanding the Donor Pool Through Intensive Care to Facilitate Organ Donation: Results of a Spanish Multicenter Study. Transplantation. 2017; 101(8):e265-e272. DOI: 10.1097/TP.0000000000001701. View

Lesieur O, Leloup M, Gonzalez F, Mamzer M . Eligibility for organ donation following end-of-life decisions: a study performed in 43 French intensive care units. Intensive Care Med. 2014; 40(9):1323-31. DOI: 10.1007/s00134-014-3409-2. View

De Groot J, van Hoek M, Hoedemaekers C, Hoitsma A, Smeets W, Vernooij-Dassen M . Decision making on organ donation: the dilemmas of relatives of potential brain dead donors. BMC Med Ethics. 2015; 16(1):64. PMC: 4574465. DOI: 10.1186/s12910-015-0057-1. View

Mazo C, Gomez A, Sandiumenge A, Baena J, Baguena M, Nuvials F . Intensive Care to Facilitate Organ Donation: A Report on the 4-Year Experience of a Spanish Center With a Multidisciplinary Model to Promote Referrals Out of the Intensive Care Unit. Transplant Proc. 2019; 51(9):3018-3026. DOI: 10.1016/j.transproceed.2019.08.025. View

Vaiman M, Gottlieb P, Bekerman I . Quantitative relations between the eyeball, the optic nerve, and the optic canal important for intracranial pressure monitoring. Head Face Med. 2014; 10:32. PMC: 4141911. DOI: 10.1186/1746-160X-10-32. View

de Lange D, Soares M, Pilcher D . ICU beds: less is more? No. Intensive Care Med. 2020; 46(8):1597-1599. PMC: 7248458. DOI: 10.1007/s00134-020-06089-0. View

Sekhon M, Griesdale D, Robba C, McGlashan N, Needham E, Walland K . Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. Intensive Care Med. 2014; 40(9):1267-74. DOI: 10.1007/s00134-014-3392-7. View

Cignarella A, Redley B, Bucknall T . Organ donation within the intensive care unit: A retrospective audit. Aust Crit Care. 2019; 33(2):167-174. DOI: 10.1016/j.aucc.2018.12.006. View

10.

Hemphill 3rd J, Bonovich D, Besmertis L, Manley G, Johnston S . The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001; 32(4):891-7. DOI: 10.1161/01.str.32.4.891. View

11.

Kentish-Barnes N, Siminoff L, Walker W, Urbanski M, Charpentier J, Thuong M . A narrative review of family members' experience of organ donation request after brain death in the critical care setting. Intensive Care Med. 2019; 45(3):331-342. DOI: 10.1007/s00134-019-05575-4. View

12.

Martin-Loeches I, Sandiumenge A, Charpentier J, Kellum J, Gaffney A, Procaccio F . Management of donation after brain death (DBD) in the ICU: the potential donor is identified, what's next?. Intensive Care Med. 2019; 45(3):322-330. DOI: 10.1007/s00134-019-05574-5. View

13.

Opdam H . Intensive Care Solely to Facilitate Organ Donation-New Challenges. Transplantation. 2017; 101(8):1746-1747. DOI: 10.1097/TP.0000000000001748. View

14.

Escudero D, Astola I, Balboa S, Leoz B, Meilan A, Del Busto C . Clinico-radiological related to early brain death factors. Med Intensiva (Engl Ed). 2021; 46(1):1-7. DOI: 10.1016/j.medine.2021.11.005. View

15.

Martin-Delgado M, Martinez-Soba F, Masnou N, Perez-Villares J, Pont T, Sanchez Carretero M . Summary of Spanish recommendations on intensive care to facilitate organ donation. Am J Transplant. 2019; 19(6):1782-1791. DOI: 10.1111/ajt.15253. View

16.

Ray A, Manara A, Mortimer A, Thomas I . Brain herniation on computed tomography is a poor predictor of whether patients with a devastating brain injury can be confirmed dead using neurological criteria. J Intensive Care Soc. 2023; 23(4):453-458. PMC: 9679895. DOI: 10.1177/17511437211040019. View

17.

Adams Jr H, Davis P, Leira E, Chang K, Bendixen B, Clarke W . Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999; 53(1):126-31. DOI: 10.1212/wnl.53.1.126. View

18.

Rivers J, Manara A, Thomas I, Derrick E . Impact of a Devastating Brain Injury Pathway on Outcomes, Resources, and Organ Donation: 3 Years' Experience in a Regional Neurosciences ICU. Neurocrit Care. 2019; 33(1):165-172. DOI: 10.1007/s12028-019-00879-1. View

19.

Martinez-Soba F, Perez-Villares J, Martinez-Camarero L, Lara R, Monzon J, Fernandez-Carmona A . Intensive Care to Facilitate Organ Donation: A Report on the Experience of 2 Spanish Centers With a Common Protocol. Transplantation. 2018; 103(3):558-564. DOI: 10.1097/TP.0000000000002294. View

20.

Souter M, Blissitt P, Blosser S, Bonomo J, Greer D, Jichici D . Recommendations for the Critical Care Management of Devastating Brain Injury: Prognostication, Psychosocial, and Ethical Management : A Position Statement for Healthcare Professionals from the Neurocritical Care Society. Neurocrit Care. 2015; 23(1):4-13. DOI: 10.1007/s12028-015-0137-6. View