title: Intensive care practices in brain death diagnosis and organ donation.
abstract: We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%).
authors.affiliation: Intensive Care Unit, Central University Hospital of Asturias, Oviedo, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Escudero
authors.affiliation: Spanish National Transplant Organization (ONT), Madrid, Spain.
authors.forename: M O
authors.initials: MO
authors.lastname: Valentín
authors.affiliation: Intensive Care Unit, Gregorio Marañón University Hospital, Madrid, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Escalante
authors.affiliation: Intensive Care Unit, Virgen de la Arrixaca Hospital, Murcia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Sanmartín
authors.affiliation: Unit of Transplants, Cell Therapy and Regenerative Medicine, Central University Hospital of Asturias, Oviedo, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Perez-Basterrechea
authors.affiliation: Intensive Care Unit, Virgen de la Arrixaca Hospital, Murcia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: de Gea
authors.affiliation: Intensive Care Unit, Central University Hospital of Asturias, Oviedo, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Martín
authors.affiliation: Intensive Care Unit, Son Espases University Hospital, Palma de Mallorca, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Velasco
authors.affiliation: Intensive Care Unit, Vall D'Hebron Hospital, Barcelona, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Pont
authors.affiliation: Intensive Care Unit, Vall D'Hebron Hospital, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Masnou
authors.affiliation: Intensive Care Unit, Gregorio Marañón University Hospital, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: de la Calle
authors.affiliation: Intensive Care Unit, Infanta Cristina University Hospital, Badajoz, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Marcelo
authors.affiliation: Intensive Care Unit, Carlos Haya Hospital, Málaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Lebrón
authors.affiliation: Intensive Care Unit, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Pérez
authors.affiliation: Intensive Care Unit, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Burgos
authors.affiliation: Intensive Care Unit, La Fe University Hospital, Valencia, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Gimeno
authors.affiliation: Intensive Care Unit, La Paz University Hospital, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Kot
authors.affiliation: Intensive Care Unit, La Paz University Hospital, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Yus
authors.affiliation: Intensive Care Unit, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Sancho
authors.affiliation: Intensive Care Unit, General Yagüe Hospital, Burgos, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Zabalegui
authors.affiliation: Intensive Care Unit, General Yagüe Hospital, Burgos, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Arroyo
authors.affiliation: Intensive Care Unit, Marqués de Valdecilla University Hospital, Santander, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Miñambres
authors.affiliation: Intensive Care Unit, Asistential Complex of Navarra, Pamplona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Elizalde
authors.affiliation: Intensive Care Unit, 12 de Octubre University Hospital, Madrid, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Montejo
authors.affiliation: Spanish National Transplant Organization (ONT), Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Domínguez-Gil
authors.affiliation: Spanish National Transplant Organization (ONT), Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Matesanz
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death / Q000175:diagnosis*; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000458:organization & administration; D011364:Professional Practice / Q000458:organization & administration; D013030:Spain / Q000453:epidemiology; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000706:statistics & numerical data; D015599:Trauma Severity Indices