title: Lack of association between decompressive craniectomy and conversion to donor status.
abstract: There has been a recent resurgence in the use of decompressive craniectomy (DC) following severe brain injury. The aim of this study was to evaluate any association between DC and solid organ donation. We performed a retrospective, single-center, cohort study involving referrals to the local organ procurement organization, excluding those with anoxic brain injury. Of subjects referred, 64 (53%) were deemed eligible for donation and 29 (24%) converted to donor status. DC was performed with similar frequency in donors and non-donors (41% vs. 29%; p = 0.23). Patients with DC had similar odds of donation as those without DC (odds ratio 1.70, 95% CI 0.72-4.03), including after adjustment for age and Glasgow Coma Scale score (odds ratio 1.31, 95% CI 0.53-3.24). The most common reason eligible patients failed to convert to donor status was failure to pursue organ procurement because of the belief that the patient would not progress to neurological death or be a candidate for donation following cardiac death. Decompressive craniectomy was not uncommon among referrals to organ procurement organizations who ultimately become solid organ donors. Continued communication between the organ donation coordinators and the treating team has potential to decrease missed opportunities for organ donation.
authors.affiliation: Department of Neurosurgery, University of Michigan, Taubman Health Care Center, Ann Arbor, MI 48109-5338, USA. jeffletc@med.umich.edu
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Fletcher
authors.forename: Karen
authors.initials: K
authors.lastname: Bergman
authors.forename: Kuanwong
authors.initials: K
authors.lastname: Watcharotone
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Jacobs
authors.forename: Devin L
authors.initials: DL
authors.lastname: Brown
mesh_terms: D001930:Brain Injuries / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D056424:Decompressive Craniectomy; D046148:Donor Selection / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*