The effect of brain death protocol duration on potential donor losses due to cardiac arrest

• Published in: Clinical transplantation Vol. 30; no. 11; pp. 1411 - 1416
• Main Authors: Westphal, Glauco Adrieno, Slaviero, Tiago Amaral, Montemezzo, Artur, Lingiardi, Gabriel Torres, de Souza, Fernanda Carolina Cani, Carnin, Tiago Costa, Soares, Diego Roberto, Hachiya, Alisson Hideto, Ferraz, Letícia Lopes, de Andrade, Joel
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.11.2016
• Subjects: Adult; brain death; Brain Death - diagnosis; Brain Death - physiopathology; Clinical Protocols; donor management; donor management goals; Female; Heart Arrest - etiology; Heart Arrest - prevention & control; Humans; Male; Middle Aged; Multivariate Analysis; organ donor; organ transplantation; Practice Guidelines as Topic; protocol duration; Retrospective Studies; Risk Factors; Time Factors; Tissue and Organ Procurement - methods; Tissue and Organ Procurement - standards; organ donor; brain death; donor management goals; organ transplantation; protocol duration; donor management
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12830

Background The severe inflammatory reaction that occurs after brain death (BD) tends to amplify over time, contributing to cardiovascular deterioration and occurrence of cardiac arrest (CA). Our purpose is to evaluate the effect of BD protocol duration (BDPD) on potential donor losses due to CA. Methods This retrospective analysis included potential donors reported during the period from May 2012 to April 2014. The risk of losses due to CA was analyzed to identify the chronological threshold at which the probability of loss due to CA increases. Results Three hundred and eighty‐four potential donors were analyzed. There was a greater chance of CA after a 30‐hour threshold (OR 1.67, 95% CI: 1.38–1.83), and the lowest risk of was identified for the range from 12 to 30 hours (OR 0.32, 95% CI: 0.19–0.52). Multivariate analysis identified the following variables as being associated with lower occurrence of CA: BDPD between 12 and 30 hours, management of a potential donor inside the intensive care unit, and the adherence to a goal‐directed protocol. Conclusion A long duration between the first clinical test for BD diagnosis and the procurement of organs may be an important risk factor for the occurrence of cardiac arrest in deceased potential donors.