Factors that affect the approach for donation of families whose relatives became brain dead
Varelas PN, Kananeh M, Brady P, Louchart L, Mehta C, Mayer SA, Abdelhak T, and Frehman M. Factors that affect the approach for donation of families whose relatives became brain dead. Neurocritical Care 2017; 27(2):S38.
Introduction All families of patients who have become brain dead (BD) should be offered the choice of donation. This does not always happen and the factors that lead to approaching them or not are not known. Our objective was to evaluate which factors influence the donation coordinators (DC) working for an organ procurement organization approach families after brain death Methods We evaluated all declarations in our hospital's BD registry between January 2006 and June 2017 regarding consent for donation and cross-matched the hospital electronic medical records with the records of the local organ procurement organization. Results After 254 BD declarations, 213 (83.9%) families were approached and 41 (16.1%) were not (including 4 families who declined to talk to the DC). Three of 22 (13.6%) families of patients who were in the donor registry were not approached. There was no difference between those approached or not based on age, sex, race, admission diagnosis or ICU type. More families of patients who completed the apnea test were approached (odds ratio, 95% CI 2.7, 1.2-6.3, p =0.016). Families of BD patients were not approached if these patients were on higher dose of norepinephrine during the 2nd BD exam, had higher peak Na+ or BUN or creatinine levels or lower PaO2 levels during the apnea test (all p < 0.05). In a logistic regression model, norepinephrine dose during the 2nd exam and creatinine level predicted nonapproach (1.04, 1.003-1.07 and 2.9, 1.01-8.6, p=0.031 and 0.047 respectively). Conclusions At our institution, the majority of BD patients' families were offered the choice of deciding about organ donation. Families who were not approached were those of patients with worse kidney function or who were more hemodynamically unstable. The decision to approach or not was not based on age, gender, race, admission diagnosis or ICU type.