Medical specific characteristics of brain dead patients related to etiology

Introduction

Understanding the progressively changing pathophysiology of brain death (BD) allows expedient diagnosis and implementation of rapid therapeutic measures that maximize successful application of transplantation. The present study investigates whether time course to BD and the incidence of subsequent homeostatic complications differed in patients with traumatic brain injury (TBI) and those with non traumatic intracranial pathology (intracerebral haemorrhage, brain tumor, post cardiac arrest anoxia-IP) and influenced source of organ donation.

Design

Retrospective chart review in a multidisciplinary ICU from January 1992 to November 2001.

Method

Patients were analyzed as to demographics, time to BD, medical complications and their incidence (diabetes insipidus [D.I.], hypotension, hypothermia, hypokalaemia). The patients were divided in two categories, those with TBI and those with IP. Estimation of data was performed using the Mann–Whitney test and χ² analysis.

Results

One hundred patients i.e. 2.03% of total admissions (n = 4150) developed BD. Solid organ donors represented 24% of brain dead patients and 0.7% of admissions. Patients' demographics, medical complications and their incidence are mentioned in the Table. Incidence of donation was equal in both categories (Table).

Table

Conclusion

Age, previous severity of illness (APACHE II score), GCS and abnormal pupil reactivity, time to BD and hypothermia constitute the most important factors that differentiate the two categories. Early donor recognition, rapid and accurate declaration of BD according to standing law are common practice in our ICU. Nevertheless the percentage of organ donation remains low compared to international standards.