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Lewis A. An Update on Brain Death/Death by Neurologic Criteria since the World Brain Death Project. Semin Neurol 2024; 44:236-262. [PMID: 38621707 DOI: 10.1055/s-0044-1786020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The World Brain Death Project (WBDP) is a 2020 international consensus statement that provides historical background and recommendations on brain death/death by neurologic criteria (BD/DNC) determination. It addresses 13 topics including: (1) worldwide variance in BD/DNC, (2) the science of BD/DNC, (3) the concept of BD/DNC, (4) minimum clinical criteria for BD/DNC determination, (5) beyond minimum clinical BD/DNC determination, (6) pediatric and neonatal BD/DNC determination, (7) BD/DNC determination in patients on ECMO, (8) BD/DNC determination after treatment with targeted temperature management, (9) BD/DNC documentation, (10) qualification for and education on BD/DNC determination, (11) somatic support after BD/DNC for organ donation and other special circumstances, (12) religion and BD/DNC: managing requests to forego a BD/DNC evaluation or continue somatic support after BD/DNC, and (13) BD/DNC and the law. This review summarizes the WBDP content on each of these topics and highlights relevant work published from 2020 to 2023, including both the 192 citing publications and other publications on BD/DNC. Finally, it reviews questions for future research related to BD/DNC and emphasizes the need for national efforts to ensure the minimum standards for BD/DNC determination described in the WBDP are included in national BD/DNC guidelines and due consideration is given to the recommendations about social and legal aspects of BD/DNC determination.
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Affiliation(s)
- Ariane Lewis
- Division of Neurocritical Care, Department of Neurology and Neurosurgery, NYU Langone Medical Center, New York
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Pérez-Blanco A, Acevedo M, Padilla M, Gómez A, Zapata L, Barber M, Martínez A, Calleja V, Rivero MC, Fernández E, Velasco J, Flores EM, Quindós B, Rodríguez ST, Virgós B, Robles JC, Nebra AC, Moya J, Trenado J, García N, Vallejo A, Herrero E, García Á, Rodríguez ML, García F, Lara R, Lage L, Gil FJ, Guerrero FJ, Meilán Á, Del Prado N, Fernández C, Coll E, Domínguez-Gil B. Assessing Outcomes of Patients Subject to Intensive Care to Facilitate Organ Donation: A Spanish Multicenter Prospective Study. Transpl Int 2024; 37:12791. [PMID: 38681973 PMCID: PMC11046399 DOI: 10.3389/ti.2024.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
Intensive Care to facilitate Organ Donation (ICOD) consists of the initiation or continuation of intensive care measures in patients with a devastating brain injury (DBI) in whom curative treatment is deemed futile and death by neurological criteria (DNC) is foreseen, to incorporate organ donation into their end-of-life plans. In this study we evaluate the outcomes of patients subject to ICOD and identify radiological and clinical factors associated with progression to DNC. In this first prospective multicenter study we tested by multivariate regression the association of clinical and radiological severity features with progression to DNC. Of the 194 patients, 144 (74.2%) patients fulfilled DNC after a median of 25 h (95% IQR: 17-44) from ICOD onset. Two patients (1%) shifted from ICOD to curative treatment, both were alive at discharge. Factors associated with progression to DNC included: age below 70 years, clinical score consistent with severe brain injury, instability, intracranial hemorrhage, midline shift ≥5 mm and certain types of brain herniation. Overall 151 (77.8%) patients progressed to organ donation. Based on these results, we conclude that ICOD is a beneficial and efficient practice that can contribute to the pool of deceased donors.
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Affiliation(s)
| | - María Acevedo
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Aroa Gómez
- Hospital Universitario Vall d’Hebrón, Barcelona, Spain
| | - Luis Zapata
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Barber
- Hospital Universitario de Navarra, Pamplona, Spain
| | | | | | - María C. Rivero
- Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Julio Velasco
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | - Sergio T. Rodríguez
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Beatriz Virgós
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - José Moya
- Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Josep Trenado
- Hospital Universitario Mútua Terrasa, Barcelona, Spain
| | | | - Ana Vallejo
- Hospital Universitario de Araba, Vitoria-Gasteiz, Spain
| | | | - Álvaro García
- Complejo Asistencial Universitario, Salamanca, Spain
| | | | | | - Ramón Lara
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | | | - Ángela Meilán
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Cristina Fernández
- Hospital Clínico Universitario de Santiago, Instituto de Investigaciones Sanitarias de Santiago, Santiago, Spain
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Gardiner D, Manara A, Dineen RA, Thomas EO. Cerebral CT angiography as an ancillary investigation to support a clinical diagnosis of death using neurological criteria: a reply. Anaesthesia 2024; 79:322-323. [PMID: 37816314 DOI: 10.1111/anae.16143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Affiliation(s)
- D Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Manara
- North Bristol NHS Trust, Bristol, UK
| | - R A Dineen
- University of Nottingham, Nottingham, UK
| | - E O Thomas
- University Hospitals NHS Trust Plymouth, Plymouth, UK
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