Irreversible Total Loss of Brain Function and Organ Donation in Patients with Aneurysmal Subarachnoid Hemorrhage.

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Irreversible Total Loss of Brain Function and Organ Donation in Patients with Aneurysmal Subarachnoid Hemorrhage.

World Neurosurg. 2017 Jun 12;:

Authors: Mohme M, Sauvigny T, Grensemann J, Söffker G, Kluge S, Westphal M, Czorlich P

Abstract
OBJECTIVE: Aneurysmal subarachnoid hemorrhage (aSAH) is a life threatening disease with an often fatal clinical course leading to irreversible total loss of brain function, i.e. brain death. The purpose of this study is to assess the prevalence and characteristics of patients with aSAH converting into organ donors after diagnosis of brain death.
METHODS: We retrospectively analyzed anonymized clinical data sets of 395 patients treated for aSAH at our university medical center within the period from 01/2011 to 12/2016. Prevalence of consent for organ donation and clinical characteristics, including parameters for diagnosis of brain death, were assessed.
RESULTS: Overall 18.0% of patients (n=71) deceased (Glasgow outcome scale 1) after initial admission to the intensive care unit. In all deceased patients intracerebral hemorrhage occurred in 42.3%, aneurysmal rebleeding in 22.5% and intraventricular hemorrhage in 87.3%. In 50.7% of deceased cases (n=36) irreversible loss of brain function was diagnosed, and 32.4% (n=23) converted into organ donors. In 55.6% an additional diagnostic EEG was applied. Male patients were converted significantly more often into organ donors than females (p=0.008). Brain death with subsequent organ donation was predominantly seen in patients younger than 60 years of age. In total 85 organs were explanted for donation, including 42 kidneys, 21 livers, 3 pancreas, 11 hearts and 8 lungs.
CONCLUSION: Brain death in the setting of fatal aneurysmal subarachnoid hemorrhage is a prevalent diagnosis with complex demands for neuro-intensive care physicians. We here demonstrate the clinical characteristics and epidemiological factors of aSAH patients converting to organ donors.

PMID: 28619501 [PubMed - as supplied by publisher]

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