Implications of ICU stay after brain death: the Saudi experience.
OBJECTIVE
The interval from brain death (BD) to organ harvesting is critical to the success of transplantation. We evaluated the time from BD onset to harvesting and analyzed sources of delay.


METHODS
This retrospective study was conducted from January 1999 to December 2003. Time intervals analyzed to determine the causes of delay were: time of admission to the intensive care unit (ICU), to the report to the Saudi Center for Organ Transplantation (SCOT), to the documentation of BD, to organ retrieval and/or cardiocirculatory cessation without organ retrieval.


RESULTS
During the 5-year analysis, 1834 people were reported to the SCOT. Of those, more than 1511 (80%) were reported during their first week of treatment in the ICU, and BD was documented in 1099 (59.9%). The mean interval from ICU admission to organ retrieval or cardiac arrest was 10.3 days and that from admission to the report to the SCOT was 5.6 days. In the consensual group, the mean interval from the documentation of BD until harvesting was 2 days, and that from documentation until cardiocirculatory cessation without organ retrieval in the nonconsensual group was 5 days. All subjects demonstrated a significant decrease in systolic blood pressure and a significant increase in plasma sodium and serum creatinine levels. The body temperature, serum plasma levels of sodium, and kidney function (measured by the serum creatinine level) of potential donors were compared, and patients with hypothermia, hypernatremia, or renal failure had a shorter stay in the ICU.


CONCLUSIONS
Fewer than 30% of the patients could be maintained on mechanical support for more than 1 week after the declaration BD. It is crucial that we increase hospital-staff awareness about the importance of organ donation and transplantation, improve the identification of BD candidates, and enable the early reporting and documentation of BD.
Al-Attar
Besher
B
Medical Department, Saudi Center for Organ Transplantation, Riyadh, Kingdom of Saudi Arabia. attarb7@hotmail.com
Shaheen
Faissal
F
Salam
Mohammed Abdul
MA
Al-Sayyari
Abdullah
A
Babiker
Abdulqayoum
A
Zakaria
Haroun
H
Babiker
Ahmed
A
Saclayan
Levi
L
D000293:Adolescent; D000328:Adult; D001926:Brain Death; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008875:Middle Aged; D012189:Retrospective Studies; D012529:Saudi Arabia; D020858:Tissue and Organ Harvesting