From the Departments of Neurology (P.N.V., M.R., C.M., P.B., M.F.K.) and Public Health Sciences (L.S.), Henry Ford Hospital, Detroit; Gift of Life of Michigan (L.L.), Ann Arbor; Henry Ford Organ Transplant Center (L.L.), Detroit, MI; and Division of Neurocritical Care and Hospital Neurology (E.F.M.W.), Mayo Clinic, Rochester, MN.
Neurology. 2021 Mar 9;96(10):e1453-e1461. doi: 10.1212/WNL.0000000000011554. Epub 2021 Jan 29.
To fill the evidence gap on the value of a single brain death (SBD) or dual brain death (DBD) examination by providing data on irreversibility of brain function, organ donation consent, and transplantation.
Twelve-year tertiary hospital and organ procurement organization data on brain death (BD) were combined and outcomes, including consent rate for organ donation and organs recovered and transplanted after SBD and DBD, were compared after multiple adjustments for covariates.
A total of 266 patients were declared BD, 122 after SBD and 144 after DBD. Time from event to BD declaration was longer by an average of 20.9 hours after DBD ( = 0.003). Seventy-five (73%) families of patients with SBD and 86 (72%) with DBD consented for organ donation ( = 0.79). The number of BD examinations was not a predictor for consent. No patient regained brain function during the periods following BD. Patients with SBD were more likely to have at least 1 lung transplanted ( = 0.031). The number of organs transplanted was associated with the number of examinations (β coefficient [95% confidence interval] -0.5 [-0.97 to -0.02]; = 0.044), along with age (for 5-year increase, -0.36 [-0.43 to -0.29]; < 0.001) and PaO level (for 10 mm Hg increase, 0.026 [0.008-0.044]; = 0.005) and decreased as the elapsed time to BD declaration increased ( = 0.019).
A single neurologic examination to determine BD is sufficient in patients with nonanoxic catastrophic brain injuries. A second examination is without additional yield in this group and its delay reduces the number of organs transplanted.
通过提供关于脑功能不可逆性、器官捐献同意和移植的相关数据，填补单一脑死亡（SBD）或双重脑死亡（DBD）检查价值的证据空白。
对 12 年的三级医院和器官获取组织的脑死亡（BD）数据进行合并，对 SBD 和 DBD 后的器官捐献同意率和器官采集与移植结果进行比较，并对多个协变量进行多次调整。
共有 266 例患者被宣布为 BD，其中 122 例为 SBD，144 例为 DBD。DBD 后平均多花 20.9 小时才能宣布 BD（ = 0.003）。SBD 患者的 75%（75/100）和 DBD 患者的 86%（86/100）家属同意捐献器官（ = 0.79）。BD 检查次数不是同意的预测因素。BD 后无患者恢复脑功能。SBD 患者更有可能至少移植 1 个肺（ = 0.031）。移植器官的数量与检查次数相关（β系数[95%置信区间]-0.5[-0.97 至-0.02]； = 0.044），还与年龄（每增加 5 岁，-0.36[-0.43 至-0.29]；<0.001）和 PaO 水平（每增加 10mmHg，0.026[0.008-0.044]； = 0.005）相关，随着宣布 BD 到检查的时间延长而减少（ = 0.019）。
非缺氧性灾难性脑损伤患者只需进行一次神经学检查即可确定 BD。在该组患者中，再次检查没有额外的收益，而其延迟会减少可移植器官的数量。
