Effect of rapid brain death determination on organ donation rates: A preliminary report

Introduction: We have previously demonstrated (hat the rapid determination of brain death using a nuclear medicine cerebral flow study results in a significant decrease in time to declaration of brain death while significantly reducing accrued hospital charges. However, by shortening die time interval until brain death is declared, donation rates may be negatively impacted. We evaluated donation rates with widespread implementation of a rapid brain death determination protocol. Methods: A retrospective chart review of trauma patients with lethal brain injuries medically eligible for organ procurement at an urban tertiary care trauma center was performed. Group I consists of 113 patients evaluated from June 1991-June 1995 using a protocol requiring two brain death exams separated by 6 or 12 hours (with/without electroencephalogram) for the ,"=gal determination of brain death. Group II consists of 14 patients evaluated from January 1996 - July 1997 using a protocol requiring a smgle brain death exam and a nuclear medicine flow scan to document absence of cerebral blood flow. Consent for organ donation as well as reason for refusal or number of organs donated was abstracted. Statistical analysis was performed using student's T-test and chi squared test where appropriate. Results: *p<0.01 vs. Group I *p<0.05 vs. Group I Group I Group II N-ELIGIBLE DONORS 113 14 FAMILY REFUSAL 63 (56%) 4 (29%) CONSENT 50 (44%) 10 (71%)* ORGANS/ELIGIBLE DONOR 1.8 ± 0.2 3.4 ± 0.6* Conclusions: In our institution, the detemination ot brain death using a single clinical exam and a nuclear medicine flow study does not adversely effect organ donation rates. In fact, in this small study population, the consent rate was significantly increased with this protocol. While the reasons for this increase in consent rates and organs harvested per eligible donor are likely multifactorial, the protocol described here appears to positively influence me family's decision to donate and thus may increase the realized organ donor pool Refusal of donation by family members continues to be a significant obstacle to organ donation.