title: First prospective study on brain stem death and attitudes toward organ donation in India.
abstract: Organ donation following brain stem death is infrequent in India. There is no prospective study on prevalence of brain stem death and causes of non-donation. Consecutive patients admitted to intensive care unit from Sep 2006 to Sep 2008 were studied prospectively. Families of those with brain stem death were approached for organ donation by transplant coordinator. Extensive awareness drive was launched. Reasons for non-donation, if any, were documented. Of 2820 patients admitted, 994 (35%) were on mechanical ventilator and 657 (23%) died. Brain stem death could be diagnosed in 55, 37 males, median age 46 years (range 7 to 87 years) i.e., 1.9% of all admissions and 8.3% of all deaths. Among neurology and neurosurgery patients brain stem death was seen in 45 of 1037 (4.3%) admissions and 45 of 161 (27.9%) deaths. Complications of brain stem death were hypotension in 49, diabetes insipidus in 17 and hypertension in 5 patients. Of 33 families counselled, 16(48%) consented to organ donation. In 14(42%), organs and tissues retrieved and transplanted included 13 livers, 23 kidneys, 25 corneas and 5 cardiac valves. Consent was more likely in females (10 of 14 as compared to 6 of 19 males, p = 0.037). Consent did not correlate with age of donor or medico-legal issues (p = 0.227 & 0.579 respectively). Trained staff with requisite systems in place produced significant organ donation rates. Religious issues and medico legal concerns were not a major hurdle towards organ donation. Female patients with brain stem were more likely to become organ donors.
authors.affiliation: Armed Forces Organ Retrieval and Transplantation Authority, Army Hospital (Research and Referral), New Delhi, India. akseth2003@yahoo.com
authors.forename: Avnish Kumar
authors.initials: AK
authors.lastname: Seth
authors.forename: Pradhi
authors.initials: P
authors.lastname: Nambiar
authors.forename: Ajay
authors.initials: A
authors.lastname: Joshi
authors.forename: Ramanathan
authors.initials: R
authors.lastname: Ramprasad
authors.forename: Rajendra
authors.initials: R
authors.lastname: Choubey
authors.forename: Pankaj
authors.initials: P
authors.lastname: Puri
authors.forename: Mandapaka
authors.initials: M
authors.lastname: Murthy
authors.forename: Sudeep
authors.initials: S
authors.lastname: Naidu
authors.forename: Anupam
authors.initials: A
authors.lastname: Saha
authors.forename: Harjinder
authors.initials: H
authors.lastname: Bhatoe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death / Q000208:ethnology*; D001926:Brain Death; D001933:Brain Stem; D002648:Child; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D045808:Refusal to Participate / Q000208:ethnology* / Q000523:psychology / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D055815:Young Adult