Retrospective Evaluation of Patients Diagnosed with Brain Death in the Intensive Care Unit: A 10-year Single Center Analysis

Öz

Aim: This study aimed to investigate the demographic characteristics, clinical features, timing of the diagnosis of brain death, and factors associated with organ donation in patients diagnosed as brain dead in the intensive care unit in the last decade. Method: Between 01.01.2015-01.06.2024, the age, gender, intensive care unit hospitalization diagnoses, the day of intensive care unit hospitalization, blood groups, the number of patients diagnosed with brain death by years, the number of patients diagnosed with brain death, the number of patients who became donors, laboratory values on the day of intensive care unit hospitalization and the day of brain death diagnosis, the reasons why families did not accept organ donation were recorded from the patients' files and hospital information system. Results: A total of 59 patients were included in the study. Of the patients, 32 (54.24%) were female and 27 (45.76%) were male. The age distribution of the patients was seven (11.86%) aged 0-17 years, 29 (49.15%) aged 18-64 years, and 23 (38.98%) aged 65 years and older. The most common intensive care unit hospitalization diagnoses were intracerebral hemorrhage (35.59%), subarachnoid hemorrhage (16.95%), and CVA (13.56%). Although brain death was diagnosed in 83.05% of the patients in the first seven days, it was diagnosed in an average of 4.81 days in all patients. When the laboratory values between the day of admission to the intensive care unit and the day of brain death were diagnosed, a statistically significant difference was found in Na+, Cl-, K+, AST, BUN, and creatinine values (p<0.05). There was no significant difference in ALT and INR values (p>0.05). Among the reasons for not accepting organ donation, familial reasons were the highest, with 79.66%. Conclusion: In order to increase the number of organ donations, it is important to raise public awareness and increase the level of knowledge of families about organ donation. Patients with poor neurological prognosis with hospitalization diagnoses such as intracranial hemorrhage, CVA, and Post CPR should be closely monitored for brain death and potential donors.

Anahtar Kelimeler

• Brain death
• Intensive care unit
• Organ donation
• Diagnosis
• Rejection

Kaynakça

1. 1.Shemie SD, Hornby L, Baker A, et al. Internationalguideline development for the determination ofdeath.Intensive Care Med. 2014;40(6):788-97.
2. 2.Wijdicks EFM, Varelas PN, Gronseth GS, Greer DM.Evidence-based guideline update: Determiningbrain death in adults: Report of the qualitystandards subcommittee of the American Academyof Neurology. Neurology. 2010;74(23):1911-8.
3. 3.Wijdicks EFM. Practice parameters fordetermining brain death in adults (summarystatement). The Quality Standards Subcommittee ofthe American Academy of Neurology. Neurology.1995;45(5):1012-4.
4. 4.Youn TS, Greer DM. Brain death and managementof a potential organ donor in the intensive care unit.Crit Care Clin. 2014;30(4):813–31.
5. 5.Nileshwar A. Care of the brain dead organ donor.Ind J Resp Care. 2016;5(2):705-12.
6. 6.Uzuntarla Y. Retrospective Investigation of BrainDeath and Organ Donation Cases in a Training andResearch Hospital. GKDA Derg. 2019;25(4):264-9.
7. 7.Palabiyik O. BeyinÖlümüTanısı AlanHastalarınRetrospektifAnalizi. OTSBD.2020;5(4):631–40.
8. 8.AkifYazar M.Evaluatıon Of Brain Death Cases inIntensive Care Units: A 6-Year Retrospective Study.Med JAnkara Tr Res Hosp. 2019;52(2);117-22.

9. 9.Cakin O, GoksenGumus A, Cengiz M, et al. OurExperience in Brain Death and Organ Donation.AkdMed J.2024;10(1):144-49.
10. Evaluationof Patients with Brain Death Diagnosis andInvestigation of the Effect of New Regulation on theDuration of Diagnosis. Turk J Intensive Care.2020;18:21-7.
11. 11.Sahin M, Altinay M, Cinar AS, Yavuz H.Retrospective Analysis of Patients DiagnosedwithBrain Death in Our Hospital in the Last 15 Years.MedBull SisliEtfal Hosp. 2023;57(4):526–30.
12. 12.Avci O, Gündoğdu O. Retrospective analysis ofthe patients with brain death diagnosis in the last 5years in our hospital. CMJ. 2019;41(2):385-91.
13. 13.Battal M, Horoz A, Karatepe O, Çitgez B.Beyinölümütespitindearaştırmahastanesideneyimi.Med Bull SisliEtfal Hosp.2013;47(2):59–62.
14. 14.Karasu D, Yılmaz C, Karaduman I, Çınar YS, PekelNB. Beyinölümü olgularınınretrospektifanalizi.YoğunBakımDerg.2015;6:23-6.
15. 15.Da Eira CSL, De Barros MIT, De AlbuquerqueAMP. Organ donation: The reality of an intensivecare unit in Portugal. Rev Bras TerIntensiva.2018;30(2):201-7.
16. 16.Kuşcu ÖÖ, Aktay M. Retrospective analysis ofbrain death cases. AnesteziDergisi. 2021;29(2):99–104.
17. 17.Dal HC. Brain Death and Organ Donation Duringthe COVID-19 Pandemic: A RetrospectiveObservational Study.CukurovaAnesteziveCerrahiBilimlerDergisi.2022;5(1);33-42.
18. 18.Güzeldaǧ S, Koca U, Ergör OA, Akan M.Retrospective analysis of adult brain death cases.TurkiyeKlinikleri Journal of Medical Sciences.2014;34(1):47–52.
19. 19.Mostafavi K, Dezfuli MM, Jarrah N, et al. Causes offamily refusal for organ donation in brain-deadcases, A Narrative Review. Koomesh.2023;25(1):113-8.
20. 20.Mojtabaee M, Ghorbani F, Mohsenzadeh M,Beigee FS. Update on Causes of Family Refusal forOrgan Donation and the Related Factors: Reportingthe Changes Over 6 Years. Transplant Proc.2018;50(1):10-3. 21.Boran O􀇆F, O􀇆ksüz H, Soylu D, et al. DemographicCharacteristics of Brain Death Cases in Our Clinicand Causes of family refusal for organ donation.YoğunBakımDerg. 2019;10(1):1-6.