title: Brain death organ donation potential and life support therapy limitation in neurocritical patients.
abstract: OBJECTIVE
  To analyze the profile, incidence of life support therapy limitation (LSTL) and donation potential in neurocritical patients.
  
  
  METHODS
  A multicenter prospective study was carried out.
  
  
  METHODS
  Nine hospitals authorized for organ harvesting for transplantation.
  
  
  METHODS
  All patients consecutively admitted to the hospital with GCS < 8 during a 6-month period were followed-up until discharge or day 30 of hospital stay.
  
  
  METHODS
  Demographic data, cause of coma, clinical status upon admission and outcome were analyzed. LSTL, brain death (BD) and organ donation incidence were recorded.
  
  
  RESULTS
  A total of 549 patients were included, with a mean age of 59.0 ± 14.5 years. The cause of coma was cerebral hemorrhage in 27.0% of the cases.LSTL was applied in 176 patients (32.1%). In 78 cases LSTL consisted of avoiding ICU admission. Age, the presence of contraindications, and specific causes of coma were associated to LSTL. A total of 58.1% of the patients died (n=319). One-hundred and thirty-three developed BD (24.2%), and 56.4% of these became organ donors (n=75). The presence of edema and mid-line shift on the CT scan, and transplant coordinator evaluation were associated to BD. LSTL was associated to a no-BD outcome. Early LSTL (first 4 days) was applied in 9 patients under 80 years of age, with no medical contraindications for donation and a GCS ≤ 4 who finally died in asystole.
  
  
  CONCLUSIONS
  LSTL is a frequent practice in neurocritical patients. In almost one-half of the cases, LSTL consisted of avoiding admission to the ICU, and on several occasions the donation potential was not evaluated by the transplant coordinator.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Institut Investigació Sanitària Pere Virgili, Tarragona, España. Electronic address: mbodi.hj23.ics@gencat.cat.
authors.forename: M A
authors.initials: MA
authors.lastname: Bodí
authors.affiliation: Coordinación de Trasplantes, Hospital Universitario Vall d'Hebrón, Barcelona, España.
authors.forename: T
authors.initials: T
authors.lastname: Pont
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Institut Investigació Sanitària Pere Virgili, Tarragona, España.
authors.forename: A
authors.initials: A
authors.lastname: Sandiumenge
authors.affiliation: Coordinación de Trasplantes, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
authors.forename: E
authors.initials: E
authors.lastname: Oliver
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Gener
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova de Lleida, Lérida, España.
authors.forename: M
authors.initials: M
authors.lastname: Badía
authors.affiliation: Servicio de Medicina Intensiva, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Mestre
authors.affiliation: Servicio de Medicina Intensiva, Hospital Sant Pau i Santa Tecla, Tarragona, España.
authors.forename: E
authors.initials: E
authors.lastname: Muñoz
authors.affiliation: Servicio de Medicina Intensiva, Hospital de Granollers, Granollers, Barcelona, España.
authors.forename: X
authors.initials: X
authors.lastname: Esquirol
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Institut Investigació Sanitària Pere Virgili, Tarragona, España.
authors.forename: M
authors.initials: M
authors.lastname: Llauradó
authors.affiliation: Organización Catalana de Trasplantes, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Twose
authors.affiliation: Servicio de Medicina Intensiva, Hospital Mutua de Terrassa, Terrassa, Barcelona, España.
authors.forename: S
authors.initials: S
authors.lastname: Quintana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001925:Brain Damage, Chronic / Q000209:etiology; D001926:Brain Death / Q000175:diagnosis; D003128:Coma / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003422:Critical Care; D005066:Euthanasia, Passive; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008020:Life Support Care / Q000706:statistics & numerical data; D008297:Male; D018447:Medical Futility; D008875:Middle Aged; D011446:Prospective Studies; D016079:Refusal to Treat / Q000706:statistics & numerical data*; D013030:Spain; D013727:Terminal Care / Q000706:statistics & numerical data; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000379:methods / Q000458:organization & administration*
keywords: Brain Death; Donación de órganos; Life Support Therapy Limitation; Limitación tratamiento de soporte vital; Muerte Encefálica; Organ Donation; Potencialidad; Potential