Donor conversion and organ yield in traumatic brain injury patients: missed opportunities and missed organs.
BACKGROUND
The purpose of this study was to define donation patterns and lost donor opportunities in severe traumatic brain injury (TBI) patients.


METHODS
The trauma registry was queried for all deaths after severe TBI in 2004; this was cross matched with the regional organ procurement organization database and subjected to post hoc statistical analysis.


RESULTS
One hundred thirty-five patients met criteria for inclusion. Forty percent had isolated TBI. Forty-two patients (31%) were eligible for deceased donation. Seventeen eligible patients (40%) did not convert to donation, 15 from family declining. Twenty-five eligible patients (60%) donated 85 organs (yield 3.4 organs/donor). Yield was similar in both isolated TBI (3.2) and patients with head injuries (3.5). Ineligible patients had higher admission Glasgow Coma Scale scores, lower head Abbreviated Injury Scale scores, and were more likely to develop cardiovascular or pulmonary dysfunction (p < 0.05). Of the 25 donors, 48% did not donate hearts and 84% did not donate lungs, despite the absence of chest trauma in the majority of patients.


CONCLUSIONS
Less than one-third of severe TBI patients were identified as eligible organ donors and only 40% actually donated. Half of all donors fail to donate hearts and over 80% fail to donate lungs. Within this population, opportunities may exist to improve both donor conversion and organ yield.
Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Clinton D
CD
Kemp
Bryan A
BA
Cotton
J Chad
JC
Johnson
Michelle
M
Ellzey
C Wright
CW
Pinson
D000328:Adult; D000704:Analysis of Variance; D001930:Brain Injuries / Q000401:mortality*; D033001:Directed Tissue Donation / Q000706:statistics & numerical data; D046148:Donor Selection / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014193:Trauma Centers