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Imminent brain death: point of departure for potential heart-beating organ donor recognition.

de Groot YJ, Jansen NE, Bakker J, Kuiper MA, Aerdts S, Maas AI, Wijdicks EF, van Leiden HA, Hoitsma AJ, Kremer BH, Kompanje EJ - Intensive Care Med (2010)

Bottom Line: Although the term is increasingly being used in recent literature, it is seldom defined in detail.Further we discussed criteria to determine irreversibility and futility in acute neurological conditions.A condition of imminent brain death requires either a Glasgow Coma Score of 3 and the progressive absence of at least three out of six brain stem reflexes or a FOUR score of E(0)M(0)B(0)R(0).

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.

ABSTRACT

Purpose: There is, in European countries that conduct medical chart review of intensive care unit (ICU) deaths, no consensus on uniform criteria for defining a potential organ donor. Although the term is increasingly being used in recent literature, it is seldom defined in detail. We searched for criteria for determination of imminent brain death, which can be seen as a precursor for organ donation.

Methods: We organized meetings with representatives from the field of clinical neurology, neurotraumatology, intensive care medicine, transplantation medicine, clinical intensive care ethics, and organ procurement management. During these meetings, all possible criteria were discussed to identify a patient with a reasonable probability to become brain dead (imminent brain death). We focused on the practical usefulness of two validated coma scales (Glasgow Coma Scale and the FOUR Score), brain stem reflexes and respiration to define imminent brain death. Further we discussed criteria to determine irreversibility and futility in acute neurological conditions.

Results: A patient who fulfills the definition of imminent brain death is a mechanically ventilated deeply comatose patient, admitted to an ICU, with irreversible catastrophic brain damage of known origin. A condition of imminent brain death requires either a Glasgow Coma Score of 3 and the progressive absence of at least three out of six brain stem reflexes or a FOUR score of E(0)M(0)B(0)R(0).

Conclusion: The definition of imminent brain death can be used as a point of departure for potential heart-beating organ donor recognition on the intensive care unit or retrospective medical chart analysis.

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Related in: MedlinePlus

Flowchart of potential organ donors
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Fig2: Flowchart of potential organ donors

Mentions: Analysis of the pool of patients, who meet the criteria of imminent brain death, should be conducted in a hierarchical order (Fig. 2). Some parameters, such as age and medical condition, are restrictive exclusion criteria. In most countries, a patient fulfilling the definition of imminent brain death, but who is older than, e.g., 75 years, will not be considered as a potential organ donor. The same holds for some medical reasons for exclusion, such as severe viral, bacterial or fungal infections and malignant neoplasm. These factors cannot be modified. After excluding the patients with these characteristics, the result is the actual pool of potential organ donors who fit every medical criterion to become a heart-beating organ donor.Fig. 2


Imminent brain death: point of departure for potential heart-beating organ donor recognition.

de Groot YJ, Jansen NE, Bakker J, Kuiper MA, Aerdts S, Maas AI, Wijdicks EF, van Leiden HA, Hoitsma AJ, Kremer BH, Kompanje EJ - Intensive Care Med (2010)

Flowchart of potential organ donors
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2921050&req=5

Fig2: Flowchart of potential organ donors
Mentions: Analysis of the pool of patients, who meet the criteria of imminent brain death, should be conducted in a hierarchical order (Fig. 2). Some parameters, such as age and medical condition, are restrictive exclusion criteria. In most countries, a patient fulfilling the definition of imminent brain death, but who is older than, e.g., 75 years, will not be considered as a potential organ donor. The same holds for some medical reasons for exclusion, such as severe viral, bacterial or fungal infections and malignant neoplasm. These factors cannot be modified. After excluding the patients with these characteristics, the result is the actual pool of potential organ donors who fit every medical criterion to become a heart-beating organ donor.Fig. 2

Bottom Line: Although the term is increasingly being used in recent literature, it is seldom defined in detail.Further we discussed criteria to determine irreversibility and futility in acute neurological conditions.A condition of imminent brain death requires either a Glasgow Coma Score of 3 and the progressive absence of at least three out of six brain stem reflexes or a FOUR score of E(0)M(0)B(0)R(0).

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.

ABSTRACT

Purpose: There is, in European countries that conduct medical chart review of intensive care unit (ICU) deaths, no consensus on uniform criteria for defining a potential organ donor. Although the term is increasingly being used in recent literature, it is seldom defined in detail. We searched for criteria for determination of imminent brain death, which can be seen as a precursor for organ donation.

Methods: We organized meetings with representatives from the field of clinical neurology, neurotraumatology, intensive care medicine, transplantation medicine, clinical intensive care ethics, and organ procurement management. During these meetings, all possible criteria were discussed to identify a patient with a reasonable probability to become brain dead (imminent brain death). We focused on the practical usefulness of two validated coma scales (Glasgow Coma Scale and the FOUR Score), brain stem reflexes and respiration to define imminent brain death. Further we discussed criteria to determine irreversibility and futility in acute neurological conditions.

Results: A patient who fulfills the definition of imminent brain death is a mechanically ventilated deeply comatose patient, admitted to an ICU, with irreversible catastrophic brain damage of known origin. A condition of imminent brain death requires either a Glasgow Coma Score of 3 and the progressive absence of at least three out of six brain stem reflexes or a FOUR score of E(0)M(0)B(0)R(0).

Conclusion: The definition of imminent brain death can be used as a point of departure for potential heart-beating organ donor recognition on the intensive care unit or retrospective medical chart analysis.

Show MeSH
Related in: MedlinePlus