Brain death and organ donation in a neurosurgical unit: audit of recent practice.
OBJECTIVE
To assess the potential for increasing the yield of donors by comparing the current pattern of brain death and organ donation in a neurosurgical unit with that reported in 1981 and with a recent national audit.


METHODS
Retrospective review of all deaths for 1986, 1987, and 1988 and prospective data for 1989.


METHODS
A regional neurosurgical unit serving 2.7 million population.


RESULTS
Of 553 deaths, 35% (191) patients died while on a ventilator and 17% (92) after discontinuation of ventilation. Medical contraindications to donation were found in 23% (32) of 141 patients tested for brain death, in 38% (19) of 50 patients who died while being ventilated who were not tested, and in 12% (11) of 92 patients no longer being ventilated. Consent for donation was sought in 88% (96) of 109 medically suitable brain dead patients and granted in 70% (67) of these. Half those with permission for multiorgan donation had only the kidneys removed.


CONCLUSIONS
More organs may be lost owing to transplant team logistics than by failure to seek consent from relatives of brain dead patients. The estimated size of the pool of potential donors depends on what types of patients might be considered. Ensuring that all who die while being ventilated are tested for brain death and considering the potential for donation before withdrawing ventilation could yield more donors. Ventilating more patients who are hopelessly brain damaged to secure more donors raises ethical and economic issues.
Gentleman
D
D
Department of Neurosurgery, Institute of Neurological Sciences, Glasgow.
Easton
J
J
Jennett
B
B
D001926:Brain Death / Q000175:diagnosis*; D001927:Brain Diseases; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008485:Medical Audit; D011446:Prospective Studies; D040841:Resource Allocation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement; D028761:Withholding Treatment