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Su Y, Zhang Y, Ye H, Chen W, Fan L, Liu G, Huang H, Gao D, Zhang Y. Promoting the process of determining brain death through standardized training. Front Neurol 2024; 15:1294601. [PMID: 38456154 PMCID: PMC10919162 DOI: 10.3389/fneur.2024.1294601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
Objective This study aims to explore the training mode for brain death determination to ensure the quality of subsequent brain death determination. Methods A four-skill and four-step (FFT) training model was adopted, which included a clinical neurological examination, an electroencephalogram (EEG) examination, a short-latency somatosensory evoked potential (SLSEP) examination, and a transcranial Doppler (TCD) examination. Each skill is divided into four steps: multimedia theory teaching, bedside demonstration, one-on-one real or dummy simulation training, and assessment. The authors analyzed the training results of 1,577 professional and technical personnel who participated in the FFT training model from 2013 to 2020 (25 sessions), including error rate analysis of the written examination, knowledge gap analysis, and influencing factors analysis. Results The total error rates for all four written examination topics were < 5%, at 4.13% for SLSEP, 4.11% for EEG, 3.71% for TCD, and 3.65% for clinical evaluation. The knowledge gap analysis of the four-skill test papers suggested that the trainees had different knowledge gaps. Based on the univariate analysis and the multiple linear regression analysis, among the six factors, specialty categories, professional and technical titles, and hospital level were the independent influencing factors of answer errors (p < 0.01). Conclusion The FFT model is suitable for brain death (BD) determination training in China; however, the authors should pay attention to the professional characteristics of participants, strengthen the knowledge gap training, and strive to narrow the difference in training quality.
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Affiliation(s)
- Yingying Su
- Brain Injury Evaluation Quality Control Center of the National Health Commission, Beijing, China
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yan Zhang
- Brain Injury Evaluation Quality Control Center of the National Health Commission, Beijing, China
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Hong Ye
- Brain Injury Evaluation Quality Control Center of the National Health Commission, Beijing, China
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Weibi Chen
- Brain Injury Evaluation Quality Control Center of the National Health Commission, Beijing, China
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Linlin Fan
- Brain Injury Evaluation Quality Control Center of the National Health Commission, Beijing, China
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Gang Liu
- Brain Injury Evaluation Quality Control Center of the National Health Commission, Beijing, China
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Huijin Huang
- Brain Injury Evaluation Quality Control Center of the National Health Commission, Beijing, China
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Daiquan Gao
- Brain Injury Evaluation Quality Control Center of the National Health Commission, Beijing, China
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yunzhou Zhang
- Brain Injury Evaluation Quality Control Center of the National Health Commission, Beijing, China
- Xuanwu Hospital Capital Medical University, Beijing, China
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Do the Senegalese Who Immigrate to Southern Europe Know About the Brain Death Concept? Transplant Proc 2019; 51:280-282. [DOI: 10.1016/j.transproceed.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/23/2018] [Indexed: 11/19/2022]
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Ríos A, López-Navas AI, Martínez-Alarcón L, Garrido G, Ayala-García MA, Ramírez P, Hernández AM, Parrilla P. Knowledge of the Concept of Brain Death Among the Latin-American Population Residing in Spain. EXP CLIN TRANSPLANT 2017; 16:473-480. [PMID: 29251586 DOI: 10.6002/ect.2017.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The knowledge of brain death is fundamental for being able to understand the organ donation process and for ensuring its acceptance or rejection. Here, we analyzed the level of knowledge of the concept of brain death among Latin-American individuals who are residents of Spain to determine the factors affecting this knowledge. MATERIALS AND METHODS Our patient group was a sample of 1314 Latin-American residents of Spain, obtained randomly and stratified according to the respondent's nationality, age, and sex. Their attitude was assessed using a validated questionnaire. The survey was self-administered and completed anonymously. RESULTS The questionnaire completion rate was 94% (n = 1237). Of total respondents, 25% (n = 313) knew the concept of brain death, which they considered to be an individual's death, 56% (n = 697) did not know the term, and 19% (n = 227) believed that it did not mean death. The variables related to knowledge of the brain death concept included (1) country of origin, with a better knowledge among those with Mexican nationality (P < .001); (2) male sex (30% vs 23%; P = .003); (3) having university-level education (35% vs 23%; P = .044); (4) having discussed the matter within the family (29% vs 23%; P = .044); (5) having a partner with a favorable attitude toward donation (39% vs 21%; P = .001); and (6) the respondent's religion (47% vs 7%; P < .001). The following factors persisted in the multivariate analysis: country of origin (odds ratio of 2.972), sex (odds ratio of 1.416), education level (odds ratio of 2.228), attitude of the respondent's partner (odds ratio of 1.835), and religion (odds ratio of 4.490). CONCLUSIONS Knowledge of the concept of brain death is limited among Latin-American residents of Spain, with marked differences among country of origin and other socio-personal factors.
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Affiliation(s)
- Antonio Ríos
- From the Proyecto Colaborativo Internacional Donante (International Collaborative Donor Project), and Surgery Service, IMIB-Virgen de la Arrixaca University Hospital, Murcia Health Service, Murcia, Spain
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Abstract
End-organ failure is associated with high mortality and morbidity, in addition to increased health care costs. Organ transplantation is the only definitive treatment that can improve survival and quality of life in such patients; however, due to the persistent mismatch between organ supply and demand, waiting lists continue to grow across the world. Careful intensive care management of the potential organ donor with goal-directed therapy has the potential to optimize organ function and improve donation yield.
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Brain stem death certification protocol. Med J Armed Forces India 2017; 74:213-216. [PMID: 30093762 DOI: 10.1016/j.mjafi.2017.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/25/2017] [Indexed: 11/23/2022] Open
Abstract
Transplantation of Human Organs is guided by laid down specific Laws in India. The organs which are targeted to be transplanted are liver, kidney and cornea. The waiting list is enormous but the donor pool is meagre. This document has been made with a view that the donor pool can be enlarged by identifying patients who are 'Brain Dead' while still not having 'Cardiac Death'. The steps include the prerequisite conditions which must be satisfied by patients who have suspicion of being brain dead, detailed examination of the patient, confirmation of the Brain Death and Counselling of the relatives for organ donation.
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Westphal GA, Garcia VD, de Souza RL, Franke CA, Vieira KD, Birckholz VRZ, Machado MC, de Almeida ERB, Machado FO, Sardinha LADC, Wanzuita R, Silvado CES, Costa G, Braatz V, Caldeira Filho M, Furtado R, Tannous LA, de Albuquerque AGN, Abdala E, Gonçalves ARR, Pacheco-Moreira LF, Dias FS, Fernandes R, Giovanni FD, de Carvalho FB, Fiorelli A, Teixeira C, Feijó C, Camargo SM, de Oliveira NE, David AI, Prinz RAD, Herranz LB, de Andrade J. Guidelines for the assessment and acceptance of potential brain-dead organ donors. Rev Bras Ter Intensiva 2017; 28:220-255. [PMID: 27737418 PMCID: PMC5051181 DOI: 10.5935/0103-507x.20160049] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.
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Affiliation(s)
- Glauco Adrieno Westphal
- Corresponding author: Glauco Adrieno Westphal, Centro
Hospitalar Unimed, Rua Orestes Guimarães, 905, Zip code: 89204-060 -
Joinville (SC), Brazil. E-mail:
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Abstract
Organ transplantation improves survival and quality of life in patients with end-organ failure. Waiting lists continue to grow across the world despite remarkable advances in the transplantation process, from the creation of public engagement campaigns to the development of critical pathways for the timely identification, referral, approach, and treatment of the potential organ donor. The pathophysiology of dying triggers systemic changes that are intimately related to organ viability. The intensive care management of the potential organ donor optimizes organ function and improves the donation yield, representing a significant step in reducing the mismatch between organ supply and demand. Different beliefs and cultures reflect diverse legislations and donation practices amongst different countries, creating a challenge to standardized practices. Maintaining public trust is necessary for continued progress in organ donation and transplantation, hence the urge for a joint effort in creating uniform protocols that ensure transparent practices within the medical community.
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Affiliation(s)
- C B Maciel
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - D Y Hwang
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - D M Greer
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
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Marchand AJ, Seguin P, Malledant Y, Taleb M, Raoult H, Gauvrit JY. Revised CT angiography venous score with consideration of infratentorial circulation value for diagnosing brain death. Ann Intensive Care 2016; 6:88. [PMID: 27620878 PMCID: PMC5020015 DOI: 10.1186/s13613-016-0188-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computed tomography angiography (CTA) is largely performed in European countries as an ancillary test for diagnosing brain death. However, CTA suffers from a lack of sensitivity, especially in patients who have previously undergone decompressive craniectomy. The aim of this study was to assess the performance of a revised four-point venous CTA score, including non-opacification of the infratentorial venous circulation, for diagnosing brain death. METHODS A preliminary study of 43 control patients with normal CTAs confirmed that the infratentorial superior petrosal vein (SPV) was consistently visible. Therefore, 76 patients (including ten with decompressive craniectomy) who were investigated with 83 CTAs to confirm clinical brain death were consecutively enrolled between July 2011 and July 2013 at a university centre. The image analysis consisted of recording non-opacification of the cortical segment of the middle cerebral artery and internal cerebral vein (ICV), which were used as the reference CTA score, as well as non-opacification of the SPV. The diagnostic performance of the revised four-point venous CTA score based on the non-opacification of both the ICV and SPV was assessed and compared with that of the reference CTA score. RESULTS The revised four-point venous CTA score showed a sensitivity of 95 % for confirming clinical brain death versus a sensitivity of 88 % with the reference CTA score. Non-opacification of the SPV was observed in 95 % of the patients. In the decompressive craniectomy group, the revised four-point CTA score showed a sensitivity of 100 % compared with a sensitivity of 80 % using the reference CTA score. CONCLUSION Compared with the reference CTA score, the revised four-point venous CTA score based on ICV and SPV non-opacification showed superior diagnostic performance for confirming brain death, including for patients with decompressive craniectomy.
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Affiliation(s)
- Antoine J Marchand
- Department of Radiology and Medical Imaging, University and Regional Hospital Center (CHRU) of Rennes, 2 rue Henri Le Guillou, 35000, Rennes, France.
| | - Philippe Seguin
- Service d'Anesthésie Réanimation 1, CHU Rennes, 2 rue Henri Le Guillou, 35000, Rennes, France.,Université Rennes 1, Rennes, France.,Inserm U991, Rennes, France
| | - Yannick Malledant
- Service d'Anesthésie Réanimation 1, CHU Rennes, 2 rue Henri Le Guillou, 35000, Rennes, France.,Université Rennes 1, Rennes, France.,Inserm U991, Rennes, France
| | - Marion Taleb
- Service d'Anesthésie Réanimation 1, CHU Rennes, 2 rue Henri Le Guillou, 35000, Rennes, France
| | - Hélène Raoult
- Department of Radiology and Medical Imaging, University and Regional Hospital Center (CHRU) of Rennes, 2 rue Henri Le Guillou, 35000, Rennes, France
| | - Jean Yves Gauvrit
- Department of Radiology and Medical Imaging, University and Regional Hospital Center (CHRU) of Rennes, 2 rue Henri Le Guillou, 35000, Rennes, France.,Université Rennes 1, Rennes, France
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Stratmann HG. Stem Cells and Organ Transplantation: Resetting Our Biological Clocks. SCIENCE AND FICTION 2016. [PMCID: PMC7124065 DOI: 10.1007/978-3-319-16015-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The human body has only a limited ability to repair itself. Illness, injury, and aging can overwhelm its built-in capability to replace dysfunctional, damaged, or destroyed tissues. We can at best only partly regenerate our organs and cannot grow back a whole limb.
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Youn TS, Greer DM. Brain death and management of a potential organ donor in the intensive care unit. Crit Care Clin 2015; 30:813-31. [PMID: 25257743 DOI: 10.1016/j.ccc.2014.06.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The concept of brain death developed with the advent of mechanical ventilation, and guidelines for determining brain death have been refined over time. Organ donation after brain death is a common source of transplant organs in Western countries. Early identification and notification of organ procurement organizations are essential. Management of potential organ donors must take into consideration specific pathophysiologic changes for medical optimization. Future aims in intensive and neurocritical care medicine must include reducing practice variability in the operational guidelines for brain death determination, as well as improving communication with families about the process of determining brain death.
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Affiliation(s)
- Teddy S Youn
- Department of Neurology, Yale University School of Medicine, LLCI 912, 15 York Street, New Haven, CT 06520, USA
| | - David M Greer
- Department of Neurology, Yale University School of Medicine, LLCI 912, 15 York Street, New Haven, CT 06520, USA.
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