Association between red blood cell distribution width and the prognosis of brain death in patients with a Glasgow Coma Scale < 6

Red blood cell distribution width (RDW) has been reported as a meaningful prognostic factor in various diseases. Our study compared patients' RDW levels and prognosis at admission and discharge time. A total of 128 patients 77 patients who suffered brain death (subject group), and 51 patients who were discharged from the hospital (control group) with GCS ≤ 6 were recruited from 60 hospitals for this study. Demographical data and RDW measurements in these patients at admission time and brain death/discharge time were extracted into two groups. 46 (35.9%) patients were females and 82 patients (64.1%) were males with a median age of 36 years old. A significant difference in baseline characteristics of GCS (P < 0.001), RDW at admission time (P < 0.001), and RDW at discharge or brain death time (P < 0.001) were noted between the two groups. In the overall population, RDW at admission time had a median value of 13.75% and was positively correlated with gender (P < 0.04, rs = 0.582) and age (P < 0.023, rs = - 0.201). Initially, there were no significant differences in RDW upon admission. However, upon discharge, although the RDW in the control group was not significant (P < 0. 1), the RDW level at the time of brain death was notably 0.45 fold higher (P = 0.001) compared to the time of admission. The standardized residuals at the two-time points showed an approximately normal distribution. The most effective RDW cut-off in Brain death was determined as 14.55. Based on the findings, using RDW as a prognostic factor has a sensitivity of 0.468 and a specificity of 0.137 in diagnosing brain death. RDW biomarker is a simple and inexpensive laboratory test that may be seen as a valuable perspective for initial patient evaluation. RDW is a powerful marker for the prognosis of brain death in patients with a GCS ≤ 6 at admission time, in order to identify a subset of patients who may require more aggressive management in the trauma center.

The Impact of Heparin Therapy in Deceased Donors on Early Graft Survival for Kidney and Liver Recipients: A Clinical Trial Study

BACKGROUND

Significant hemodynamic, hormonal, and metabolic impairment of a brain-dead organ donor is often associated with the deterioration of graft viability. This study aimed to compare the effect of heparin therapy as a therapeutic dose after brain death confirmation on early graft survival in kidney and liver recipients.

METHOD AND MATERIALS

The deceased donors were sorted into two groups based on their D-dimer level. After confirming brain death, one group was given a heparin injection (case group), while the other group did not receive any heparin (control group). A total of 71 brain death donors and matched kidney and liver transplants were included in the case group. A total of 43 brain death donors and matched kidney and liver transplants were included in the control group. A total of 5000 units of heparin were administered every 6 hours to the deceased donor case group.

RESULTS

The mean age of the case and control groups were 36.27 ± 16.13 and 36.15 ± 18.45, respectively. An independent t test showed that there were no differences between the number of procured organs in both groups (p = 0.29). There was no significant difference between the graft survival rate and the doses of heparin injection to the liver recipients (p = 0.06). However, a significant difference was revealed between the graft survival rate and the dose of heparin injection (p = 0.004) in kidney recipients.

CONCLUSIONS

The data suggest that administering low therapeutic doses of heparin to donors before organ donation may potentially prevent thrombosis and provide a protective benefit. We showed that heparin therapy had no significant effect on the number of donated organs and graft survival.

Trends in organ donation and transplantation over the past eighteen years in Iran

BACKGROUND

This article will review the trends in organ donation over the past 18 years in Iran.

MATERIAL AND METHODS

All donation and transplantation statistics were extracted by reviewing the Organ Procurement and Transplantation database of the Ministry of Health of Iran from 2002 to 2019.

RESULTS

Iran's national deceased donation rate from 2002 to 2019 increased 19.06-fold from .75 to 14.3 per million population (PMP). After the beginning of the COVID-19 pandemic, the rate of organ donation in Iran decreased significantly. Although 1 year after the onset of the pandemic, due to the widespread adoption of COVID19 vaccination, the rate of organ donation began to increase again, this system is still under performing. During the years under examination, the rate of deceased kidney donation increased significantly compared to living kidney donation and reached up to 2001 kidney transplantations in 2021. From 2002 to 2019, the rate of liver transplants increased to 12.8. Likewise, the rate of heart transplants increased 8.4-fold, from 15 to 126 cases during the same time.

CONCLUSSION

Although a personal choice, the process of organ donation involves medical, legal, ethical, organizational, and social aspects. The trend in increasing donation rates over the past years can be attributed to multiple influences, which include rigorous team efforts in the organ donation and transplantation systems, in addition to creating a donation culture and promoting donation through media platforms. Moreover, we can say that the rising rates of deceased donor transplantation also can drive down rates of commercial living donor transplantation.

Is there any relationship between red blood cell distribution width and prognosis of brain death?

Background

Accumulating evidence has demonstrated that RDW (red blood cell distribution width) may independently predict clinically important outcomes in many populations. However, the role of RDW has not been elucidated in brain death. We conducted this study with the aim of evaluating the predictive value of RDW in brain death.

Methods

A retrospective study of seventy-seven of brain death cases during 36 months were evaluated at university hospitals, affiliated in Tehran, Iran. Demographical data include age, sex, BMI and cause of brain death, also laboratory results (red blood cell distribution, mean corpuscular volume, hemoglobin) collected by checklists from patient records. Having the three RDW measurements (days of hospital admission, day of brain death, and day of cardiac arrest) required.

Results

Time interval from hospital admission until brain death was 5.27±4.07. The mean age of brain death cases was 32.65±16.53. The mean RDW values on days of hospital admission, the day of brain death, and the day of cardiac arrest were 14.53±1.98, 15.12±1.93 and 15.18±2.07, respectively. Results of the repeated-measures ANOVA test reveal that RDW level was constantly higher in the traumatic patient group compared to the non-traumatic ones (P=0.008).

Conclusion

The frequency of brain death was high in patients with high RDW values. RDW might be a prognostic biomarker for brain death. More prospective studies with large sample size and long follow-up period should be carried out to determine the prognostic significance of RDW and brain death in future.

The influence of socioeconomic factors on deceased organ donation in Iran

Background

There is a large gap between the number of patients on organ waiting lists and the number of available organs for donation. This study investigated the socioeconomic factors in Iran that influenced decisions for organ donation among the families of brain-dead donors.

Methods

This retrospective cross-sectional study was performed among the families of 333 organ donors in Iran. Two trained researchers interviewed family members about the donor’s age, sex, cause of brain death, education level, marital status, number of children, history of addiction, the financial status of the donor’s family, and reasons for which they considered refusing organ donation.

Results

The mean age of the donors was 37.23±16.59 years. During 2017–2019, significant differences were found according to income (P<0.001), marital status (P<0.001), sex (P=0.04), and occupation (P=0.04). More than half of the organ donors were of low socioeconomic status, and nearly half were the sole income earners of large families. Trauma was the most common cause of death (44.6%). The most common reasons for which the families considered refusing organ donation were unfamiliarity with the concept of brain death, denial, and the expectation of a miracle.

Conclusions

The donor’s socioeconomic status and availability of social services, such as insurance coverage, psychological services, and mourning therapy courses, play an important role in organ donation. Adequate support for the deceased’s family after organ donation is imperative.