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The concept of brain death developed with the advent of mechanical ventilation, and guidelines for determining brain death have been refined over time.
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The most current guidelines, the 2010 American Academy of Neurology practice parameters for brain death determination in adults, necessitate 3 clinical findings: irreversible coma from a known cause, brainstem areflexia, and apnea.
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Despite efforts to develop standardized guidelines, there is a large degree of practice variability, including the
Brain Death and Management of a Potential Organ Donor in the Intensive Care Unit
Section snippets
Key points
Practice Before the American Academy of Neurology Guidelines
In 1968, a committee commissioned by Harvard Medical School involving physicians, a theologian, a lawyer, and a historian of science examined irreversible coma as a new criterion for death.7 In their report, coma in an individual with no discernible central nervous system (CNS) activity was defined by 4 features: (1) unreceptivity and unresponsiveness; (2) absent movements or breathing; (3) absent reflexes; and (4) an isoelectric electroencephalogram (EEG).8 Confounders such as hypothermia
Management of potential organ donor
Patients in the intensive care unit (ICU) declared dead by neurologic criteria (or by circulatory criteria) are potential organ donors. Because of the shortage of available organs for donation, optimizing appropriate management of potential donors is of great importance.43, 44, 45, 46, 47 One donor has the potential to affect the lives of 7 or more people.
The family meeting
The family meeting is an important time to understand the patient’s wishes, afford an opportunity to comfort the family, address their needs, and set the tone to deliver bad news in a compassionate manner, a hallmark of high-quality ICU care.68 It is important to establish a relationship with the family before the discussion of brain death, preferably before brain death testing, so that the family can understand the treatment plan and steps that will be taken in the care of their loved one.
Summary
With technological advances such as positive pressure ventilation and organ transplantation, modern medicine has caused a reevaluation of our basic presuppositions about the biological phenomenon of death, for which society has constructed pragmatic, medical, moral, and legal policies.72 Despite periodic controversy, a vast majority consensus exists on what constitutes brain death and which criteria are necessary in its determination. A similar consensus exists on the dead donor rule, which
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Deceased donor kidney procurement: systematic review of the surgical technique
2023, Actas Urologicas EspanolasOrgan donation in the US and Europe: The supply vs demand imbalance
2021, Transplantation ReviewsCitation Excerpt :Emphasis needs to be given to the psychological support of family members and healthcare professionals, especially when neonatal DCD takes place [15]. In the US in 1968, the Uniform Anatomical Gift Act (UAGA) initiated a regulatory framework for organ donations for individuals over 18 [8,16]. This led to the administration of the Organ Procurement and Transplantation Network (OPTN) in the US [8,17].
Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2
2020, Journal of the Neurological SciencesAdherence to guidelines for the management of donors after brain death
2019, Journal of Critical CarePredictors of Organ Donation Among Patients With Brain Death in the Intensive Care Unit
2018, Transplantation ProceedingsOrgan donor management: Eight common recommendations and actions that deserve reflection
2017, Medicina IntensivaCitation Excerpt :In general, peripheral conversion of T4–T3, the physiologically active hormone, decreases in an inflammatory environment or with administration of catecholamines or glucocorticoids. Majority of guidelines and some authors recommend the administration of intravenous or oral thyroid hormones, either T3 or T4, in all donors8,14,15,17,20,31,32,34,56 or at least in donors with ventricular dysfunction12,25,29,30 or with important hemodynamic alterations.3,18,22,25,57 These recommendations are based on retrospective studies and non-comparative studies.58
Conflicts of Interest: The authors have no relevant conflicts of interest to declare.
Disclosures: None.