Comparison of 1 vs 2 Brain Death Examinations on Time to Death Pronouncement and Organ Donation: A 12-year Single Center Experience

OBJECTIVE: To fill the evidence gap on the value of a single (SBD) or dual brain death (DBD) exam by providing data on irreversibility of brain function, organ donation consent and transplantation. METHODS: 12-year tertiary hospital and organ procurement organization data on brain death (BD) were combined and outcomes, including consent rate for organ donation and organs recovered and transplanted after SBD and DBD were compared after multiple adjustments for co-variates. RESULTS: two-hundred sixty-six patients were declared BD, 122 after SBD and 144 after DBD. Time from event to BD declaration was longer by an average of 20.9 hours after DBD (p=0.003). Seventy-five (73%) families of patients with SBD and 86 (72%) with DBD consented for organ donation (p=0.79). The number of BD exams was not a predictor for consent. No patient regained brain function during the periods following BD. Patients with SBD were more likely to have at least one lung transplanted (p = 0.033). The number of organs transplanted was associated with the number of exams [beta coefficient, (95% CI) -0.5 (-0.97 to -0.02), p=0.044], along with age (for 5 year increase, -0.36 (-0.43 to -0.29), p\u3c0.001) and PaO2 level (for 10 mmHg increase, 0.026 (0.008 to 0.044), p=0.005) and decreased as the elapsed time to BD declaration increased (p=0.019). CONCLUSIONS: A single neurologic examination to determine brain death is sufficient in patients with non-anoxic catastrophic brain injuries. A second examination is without additional yield in this group and its delay reduces the number of organs transplanted

Consent rate for organ donation after brain death: A single center experience over 11 years

Objective: To evaluate potential factors that played a role in the consent rate in a large tertiary hospital over a period of 11 years. Background: Many patient, family and hospital factors have been associated with obtaining consent for organ donation after brain death (BD), including decoupling, trained requester and translation. Design/Methods: We evaluated all BD declarations in our hospital between 2006 and 2016 regarding consent for donation. We cross-matched the hospital electronic medical records with the records of the local organ procurement organization to identify this population. Results: The Organ Procurement Organization (OPO) spoke to 199 families (58.7% African American (AA), 47.2% female, mean age of 48.2 years). Another 39 families were never approached. There was a 71.4% consent rate. There was no significant relationship between sex, admission diagnosis, ICU (neuro vs. medical vs. surgical), physician speciality (neurology vs. other), time from event to BD declaration or religion and decision to donate. Families were more likely to consent to donation if the patient was non-AA (87.3% vs 62% if AA, p\u3c0.001), had developed diabetes insipidus (72.3% vs 27.7%, p=0.008), was younger (46.6±17.3 vs 52.1±15.6 years, p= 0.039), had a lower BUN at the time of death (17.7±16.7 vs 24.4±20.3 mg/dL, p=0.027), and had a higher PaO2 at the time of the apnea test (225.2±129.8 vs 185.9±111.8 mmHg, p=0.041). In a logistic regression model, only AA race and PaO2 independently predicted refusal of donation (odds, 95%CI, 4.9, 2-12.1, p=0.001 and 0.996, 0.993-0.999, p= 0.013, respectively). Conclusions: Although the majority of BD patients in this large series were AA, their families were almost 5 times less likely to consent for organ donation than non-AA families. There is an urgent need to explore the reasons for low donation rates in this population

Single or dual brain death exams: Tertiary hospital experience over 11.5 years

Objective: To evaluate adoption of and reason for performing a single brain death exam (SBD) vs two (dual) brain death exams (DBD) and their impact on organ function and consent for organ donation. Background: Our hospital policy allows an optional SBD (with an apnea and a cerebral blood flow test) or a DBD (with an apnea test). Design/Methods: We evaluated our hospital\u27s BD registry between January 2006 and June 2017 regarding SBD or DBD. We also cross-matched our electronic medical records with the records of the local organ procurement organization. Results: Of 251 BD declarations, 115 (46%) were SBD and 136 (54%) DBD. During the 1 five years, 43% of all BD exams were SBD and during the second 57%. Patients with SBD were older (50.6±16.5 for SBD vs 46.5±17.1 years for DBD, p= 0.057), had a primary neurologic diagnosis (96% vs 47%, p\u3c 0.001) and were admitted to the Neuro- ICU (74% vs 27%, p\u3c 0.001). During the 2 exam, 76.7% patients were on equal or higher dose of pressors. SBD patients had lower K+, BUN, creatinine and heart st nd rate, but higher peak Na+ and apnea PaO2 (for all

Consent rate for organ donation after brain death: A single center\u27s experience over 11.5 years

Objective: To compare different social and medical factors that affect organ donation in the intensive care units. Background: Many patient, family and hospital factors have been associated with obtaining consent for organ donation after brain death (BD). We evaluated potential factors that played a role in the consent rate in a large tertiary hospital over a period of 11.5 years. Design/Methods: We evaluated all BD declarations in our hospital between 2006 and 2017 regarding consent for donation. We cross-matched the hospital electronic medical records with the records of the local organ procurement organization to identify this population. Results: The organ procurement organization (OPO) spoke to 208 families (58.7% African American (AA), 48% female, mean age of 48.1 years). Another 43 families were never approached. There was a 72% consent rate. There was no significant relationship between sex, admission diagnosis, ICU (neuro vs. medical vs. surgical), physician specialty (neurology vs. other), time from event to BD declaration or religion and decision to donate. Families were more likely to consent to donation if the patient was non-AA (88% vs 62% if AA,

Factors that affect consent rate for organ donation after brain death: A 12-year registry

OBJECTIVE: To account for factors affecting family approach and consent for organ donation after brain death (BD). MATERIAL AND METHODS: A prospective cohort study in a large, tertiary, urban hospital, where we reviewed the database of all brain-dead patients between January 2006 and December 2017 cross-matched with local organ procurement organization (OPO) records. RESULTS: Two-hundred sixty-six brain-dead patients were included (55% African Americans (AAs)). Two-hundred twenty-two were approached for donation. The reason for not approaching families was medical exclusion due to cancer or multi-organ failure. Patient demographics or religion were not associated with approaching families. Lower creatinine level was the only independent factor associated with higher approach. Consent rate for organ donation was 72.5%. Consent was significantly higher in Caucasians (89% vs 62% for AAs), younger patients (46.7 vs 52.5 years old), in patients with lower creatinine at time of death (1.7 vs 2.4 mg/dL), patients for whom apnea testing was completed (92% vs 80%) and patients with diabetes insipidus (DI) (72% vs 54%). There was no significant relationship between consent and patient gender, admission diagnosis, number of examinations or completion of a confirmatory test. In a logistic regression model, only AA race independently predicted consent for donation (odds, 95% CI, 0.27, 0.12-0.57 p \u3c .001). In a different model, apnea test completion was an additional independent predictor (3.66, 1.28-10.5 p = .015). CONCLUSIONS: Approaching families for organ donation consent was associated with medical suitability only and not with demographic or religious characteristics. AAs were 3.7 times less likely to consent for organ donation than non-AAs. Completion of apnea testing was associated with higher consent rates, an observation that needs to be explored in future studies documenting the effect on bedside family presence during this test

Automated optical approaches for in vivo multiscale monitoring of phytoplankton communities and HABs in the English Channel and North Sea

International audienceAutomated optical observations of phytoplankton communities are currently implemented in eastern English Channel and southern North Sea on different platforms (fixed autonomous stations, moorings, dedicated cruises and measurements/ships of opportunity) as a complement of long term monitoring networks in the. These marginal seas are characterized by significant connectivity to adjacent ocean and seas, strong hydrodynamics and low to high riverine inputs, influencing biogeochemical and biological processes like high productivity and recurring phytoplankton blooms, including some Harmful Algal Blooms-HABs of potential impact on marine food webs, as well as on human health and economy. Integrated phytoplankton observations are carried out combining reference methods with innovative automated in vivo imaging inflow/in situ/benchtop devices, pulse shape-recording flow cytometers, as well as in vivo multispectral fluorometers. These measurements provide information on the distribution and dynamics of phytoplankton functional groups (flow cytometry) and main taxa (imaging) at high spatial and temporal resolution assigning community changes to different bloom situations and pelagic habitats state, complementing physical, biogeochemical and biological variables. The in vivo approaches allow tracking HABs at different spatial and temporal scales, through the harmonisation of observations (including near-real time in vivo automated approaches implemented for almost a decade), at almost real time, and become a helpful tool for managers of these events. Finally, harmonisation in data pipelines conform to the FAIR principle and synthesis based on conventional statistics as well as on IA/ML approaches makes it possible to address scientific, societal and economic challenges through a new perspective, facing global and local changes

Automated optical approaches for in vivo multiscale monitoring of phytoplankton communities and HABs in the English Channel and North Sea

International audienceAutomated optical observations of phytoplankton communities are currently implemented in eastern English Channel and southern North Sea on different platforms (fixed autonomous stations, moorings, dedicated cruises and measurements/ships of opportunity) as a complement of long term monitoring networks in the. These marginal seas are characterized by significant connectivity to adjacent ocean and seas, strong hydrodynamics and low to high riverine inputs, influencing biogeochemical and biological processes like high productivity and recurring phytoplankton blooms, including some Harmful Algal Blooms-HABs of potential impact on marine food webs, as well as on human health and economy. Integrated phytoplankton observations are carried out combining reference methods with innovative automated in vivo imaging inflow/in situ/benchtop devices, pulse shape-recording flow cytometers, as well as in vivo multispectral fluorometers. These measurements provide information on the distribution and dynamics of phytoplankton functional groups (flow cytometry) and main taxa (imaging) at high spatial and temporal resolution assigning community changes to different bloom situations and pelagic habitats state, complementing physical, biogeochemical and biological variables. The in vivo approaches allow tracking HABs at different spatial and temporal scales, through the harmonisation of observations (including near-real time in vivo automated approaches implemented for almost a decade), at almost real time, and become a helpful tool for managers of these events. Finally, harmonisation in data pipelines conform to the FAIR principle and synthesis based on conventional statistics as well as on IA/ML approaches makes it possible to address scientific, societal and economic challenges through a new perspective, facing global and local changes