Anti-infective management in brain-dead organ donors - A retrospective analysis at two centers reveals need for improvement.

BACKGROUND

Adequate donor management is essential to increase the number of transplantable organs. No specific recommendations about anti-infective management for organ donors are available and the sparse literature indicates that antimicrobials are used too liberally. We analyzed anti-infective management of brain-dead donors to add to the limited evidence.

METHODS

All brain-dead donors at the University Hospitals Münster (2010-2024) and Bielefeld Bethel (2020-2024) were retrospectively included. The use and indication of antimicrobials, microbiological diagnostics and inflammatory markers were assessed during intensive care unit stay and organ retrieval.

RESULTS

149 donors were included, 76.5 % received antimicrobials in the intensive care unit and 21.5 % during organ retrieval. Antimicrobial exposure did not correlate between both periods. Indication for antimicrobials was documented in 61 % of donors, with aspiration pneumonia (33 %) and ventilator-associated pneumonia (33 %) being the most common diagnoses. Positive microbiological cultures were found in 36 % of donors but without correlation to antimicrobial exposure or length of exposure. The proportion of donors with out of normal range values for C-reactive protein (67-100 %), white blood cell count (53-88 %) and procalcitonin (22-43 %) was high, but only C-reactive protein differed between the day before and the day of brain death diagnosis and between infected and non-infected donors.

CONCLUSION

Antimicrobial use was high during intensive care unit stay, low during organ retrieval and inconsistent between both periods. Inflammatory markers were insufficient to indicate infection. Aggravated by a lack of evidence-based recommendations, this indicates inadequate anti-infective management of DBD donors, which may have a negative impact on the organ recipient.