Imminent brain death: point of departure for potential heart-beating organ donor recognition.
OBJECTIVE
There is, in European countries that conduct medical chart review of intensive care unit (ICU) deaths, no consensus on uniform criteria for defining a potential organ donor. Although the term is increasingly being used in recent literature, it is seldom defined in detail. We searched for criteria for determination of imminent brain death, which can be seen as a precursor for organ donation.


METHODS
We organized meetings with representatives from the field of clinical neurology, neurotraumatology, intensive care medicine, transplantation medicine, clinical intensive care ethics, and organ procurement management. During these meetings, all possible criteria were discussed to identify a patient with a reasonable probability to become brain dead (imminent brain death). We focused on the practical usefulness of two validated coma scales (Glasgow Coma Scale and the FOUR Score), brain stem reflexes and respiration to define imminent brain death. Further we discussed criteria to determine irreversibility and futility in acute neurological conditions.


RESULTS
A patient who fulfills the definition of imminent brain death is a mechanically ventilated deeply comatose patient, admitted to an ICU, with irreversible catastrophic brain damage of known origin. A condition of imminent brain death requires either a Glasgow Coma Score of 3 and the progressive absence of at least three out of six brain stem reflexes or a FOUR score of E(0)M(0)B(0)R(0).


CONCLUSIONS
The definition of imminent brain death can be used as a point of departure for potential heart-beating organ donor recognition on the intensive care unit or retrospective medical chart analysis.
Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Yorick J
YJ
de Groot
Nichon E
NE
Jansen
Jan
J
Bakker
Michael A
MA
Kuiper
Stan
S
Aerdts
Andrew I R
AI
Maas
Eelco F M
EF
Wijdicks
Hendrik A
HA
van Leiden
Andries J
AJ
Hoitsma
Berry H P H
BH
Kremer
Erwin J O
EJ
Kompanje
D001926:Brain Death / Q000175:diagnosis*; D003422:Critical Care / Q000458:organization & administration*; D005060:Europe; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011361:Professional Competence; D011785:Quality Assurance, Health Care; D014019:Tissue Donors / Q000145:classification; D020858:Tissue and Organ Harvesting / Q000941:ethics / Q000379:methods*; D009927:Tissue and Organ Procurement / Q000941:ethics / Q000458:organization & administration*; D028761:Withholding Treatment / Q000941:ethics / Q000592:standards*