ORIGINAL ARTICLES  CRITICAL AND INTENSIVE THERAPY Free access

Minerva Anestesiologica 2001 January-February;67(1-2):71-8

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Deaths with acute cerebral lesion and heart-beating potential organ donors in the Veneto Region

Procaccio F., Barbacini S., Meroni M., Sarpellon M., Verlato R., Giron G. P.

On behalf of the Working Group of the Fondazione per l’Incremento dei Trapianti d’Organo (FITO)* Veneto, Italy. E-mail: fito@fito.it

Back­ground. The ­study was ­aimed at describ­ing the clin­i­cal char­ac­ter­is­tics of ­dead ­patients ­with ­acute cere­bral ­lesion and ana­lyz­ing rea­sons of the short­age of ­heart-beat­ing poten­tial ­organ ­donors in the Inten­sive ­Care ­Units (­ICUs) in the Vene­to ­Region.
Meth­ods. ­Data ­have ­been pros­pec­tive­ly record­ed in 23 ­ICUs ­over six ­months for ­deceased ­patients ­with ­acute cere­bral ­lesion (clin­i­cal ­data, ­death diag­no­sis) and for any poten­tial ­organ ­donor (med­i­cal suit­abil­ity, fam­i­ly inter­view, ­organ retriev­al).
­Results. In the ­ICUs of the Vene­to ­Region in 1998 ­deceased ­patients ­with ­acute cere­bral ­lesion ­were 187 per mil­lion pop­u­la­tion (p.m.p.); 317 cas­es ­have ­been stud­ied. ­Median age was 64 ­years (­range 7-93). ­Heart-beat­ing ­death was legal­ly con­firmed ­only in 98/317 cas­es (31%) ­against a clin­i­cal diag­no­sis of ­brain ­death in 203/317 (64%). ­Only 82/317 (26%) ­were con­sid­ered eli­gible ­donors and 48/317 (15%) ­became ­real ­donors (22.8 p.m.p.). ­Among the remain­ing 235 cadav­ers, 105 ­were ­over 70 ­years old. In the ­group of 130 ­under 70 ­years abso­lute con­tra­in­di­ca­tions ­were ­present ­only in 30 and “prob­le­mat­i­cal” clin­i­cal sit­u­a­tions ­were report­ed in 100.
Con­clu­sions. The num­ber of ­deaths ­with ­acute cere­bral ­lesion rep­re­sents a sen­sible ­index and a key fac­tor for eval­u­at­ing the poten­tial ­organ ­donor ­pool in ­small ­regions and in the sin­gle inten­sive ­care ­unit. Col­lect­ed ­data dem­on­strate ­that in the Vene­to ­Region the effi­cien­cy of sol­id ­organ retriev­al can be ­improved and ­that ­organ ­donor short­age may ­depend, ­beyond fam­i­ly refu­sal, on clin­i­cal and cul­tu­ral fac­tors ­that ham­per sta­bi­lized ­heart-beat­ing ­deaths. ­Most poten­tial ­donors ­with age ­over 70 or “prob­le­mat­i­cal” clin­i­cal sit­u­a­tions are pre­ven­tive­ly exclud­ed by ­ICUs’ phy­si­cians. To ­improve ­organ dona­tion all the ­patients who die in ­spite of neu­ro-inten­sive treat­ment ­should be pre­vent­ed ­from cir­cu­la­to­ry ­arrest to per­mit ­legal dec­lar­a­tion of ­death. ­Thus ­more poten­tial ­organ ­donors with­out abso­lute con­tra­in­di­ca­tions ­could be recov­ered and ­time ­would ­exist for dis­cuss­ing any prob­le­mat­i­cal sit­u­a­tion ­with ­experts in ­organ pro­cure­ment, par­tic­u­lar­ly in ­respect to exist­ing urgen­cies in the wait­ing ­list.