Imminent brain death: point of departure for potential heart-beating organ donor recognition
- Yorick J. de GrootAffiliated withDepartment of Intensive Care, Erasmus MC University Medical Center Rotterdam
- , Nichon E. JansenAffiliated withDutch Transplant Foundation
- , Jan BakkerAffiliated withDepartment of Intensive Care, Erasmus MC University Medical Center Rotterdam
- , Michael A. KuiperAffiliated withDepartment of Intensive Care, Medical Center Leeuwarden
- , Stan AerdtsAffiliated withDepartment of Intensive Care, Isala Clinics
- , Andrew I. R. MaasAffiliated withDepartment of Neurosurgery, University Hospital Antwerp
- , Eelco F. M. WijdicksAffiliated withDivision of Critical Care Neurology, Mayo Clinic
- , Hendrik A. van LeidenAffiliated withDutch Transplant Foundation
- , Andries J. HoitsmaAffiliated withDepartment of Nephrology, University Medical Center St Radboud
- and 2 more
There is, in European countries that conduct medical chart review of intensive care unit (ICU) deaths, no consensus on uniform criteria for defining a potential organ donor. Although the term is increasingly being used in recent literature, it is seldom defined in detail. We searched for criteria for determination of imminent brain death, which can be seen as a precursor for organ donation.
We organized meetings with representatives from the field of clinical neurology, neurotraumatology, intensive care medicine, transplantation medicine, clinical intensive care ethics, and organ procurement management. During these meetings, all possible criteria were discussed to identify a patient with a reasonable probability to become brain dead (imminent brain death). We focused on the practical usefulness of two validated coma scales (Glasgow Coma Scale and the FOUR Score), brain stem reflexes and respiration to define imminent brain death. Further we discussed criteria to determine irreversibility and futility in acute neurological conditions.
A patient who fulfills the definition of imminent brain death is a mechanically ventilated deeply comatose patient, admitted to an ICU, with irreversible catastrophic brain damage of known origin. A condition of imminent brain death requires either a Glasgow Coma Score of 3 and the progressive absence of at least three out of six brain stem reflexes or a FOUR score of E0M0B0R0.
The definition of imminent brain death can be used as a point of departure for potential heart-beating organ donor recognition on the intensive care unit or retrospective medical chart analysis.
KeywordsBrain death Critical care organisation Neurotrauma Transplantation Stroke Emergency medicine
- Imminent brain death: point of departure for potential heart-beating organ donor recognition
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Intensive Care Medicine
Volume 36, Issue 9 , pp 1488-1494
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- Brain death
- Critical care organisation
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- Author Affiliations
- 1. Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- 2. Dutch Transplant Foundation, Leiden, The Netherlands
- 3. Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- 4. Department of Intensive Care, Isala Clinics, Zwolle, The Netherlands
- 5. Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium
- 6. Division of Critical Care Neurology, Mayo Clinic, Rochester, MN, USA
- 8. Department of Nephrology, University Medical Center St Radboud, Nijmegen, The Netherlands
- 7. Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands