Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study
Yıl: 2020 Cilt: 21 Sayı: 2 Sayfa Aralığı: 115 - 119 Metin Dili: İngilizce DOI: 10.4274/imj.galenos.2020.71463 İndeks Tarihi: 17-10-2020
Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study
Öz: Introduction: The possibility of brain death (BD) amongpatients with a Glasgow Coma scale <7 must be considered byphysicians who work in intensive care units. Deceased organtransplantation can be lifesaving so every BD patient should beseen as a potential donor. The aim of this study was to describethe causes of BD, rate of organ donation and to investigate theeffect of diagnosis time on donation rates in our hospital overa 9-year period.Methods: After obtaining Institutional Ethics Committeeapproval, we conducted a retrospective review of patients whohad sustained BD in our hospital between January 1, 2004 andJanuary 1, 2013. Patients’ age, methods used to diagnose BD,duration of survival after diagnosis, whether patients’ familymembers gave consent to organ donation, and organ donationrates were reviewed.Results: Sixty patients were declared BD, of whom 21 (35%)were female and 39 (65%) were male. Their mean age was 28years. Only 6 (10%) patients’ families gave consent for donation.The most common cause of BD was traumatic brain injury(n=37, 62%). Internal carotid artery doppler ultrasonographywas performed in 36 (60%) patients; cerebral angiography wasperformed in 14 (23%) patients; and electroencephalographywas performed in two patients. The mean time from hospitaladmission to diagnosis of BD was 5.16±3.06 days overall;5.5±0.4 days among non-donors; and 2.0±0.4 days amongdonors. The mean time from diagnosis of BD to death innon-donors was 2.4±0.3 days. In donors, the mean time fromdiagnosis of BD to harvesting of the patient’s organs was1.08±0.2 days.Conclusion: In our hospital, the rate of organ donation afterBD is low. It is found that the time to confirm the diagnosisof BD was significantly shorter in donors than non-donors.It is believed that early diagnosis of BD is associated with anincreased rate of family approval for organ donation.
Anahtar Kelime: Beyin Ölümü Erken Tanısının Organ Bağış Oranına Etkisinin Retrospektif Analizi
Öz: Amaç: Yoğun bakımda takip edilen Glasgow Koma skoru 7’nin altındaki hastalarda beyin ölümü gelişme ihtimaline karşı uyanık olunmalıdır. Kadavradan organ nakli; nakil sırası bekleyen hasta sayısını düşüreceğinden hayat kurtarıcıdır. Bu nedenle her beyin ölümü tanısı konan hastaya potansiyel donör gözüyle bakılmalıdır. Çalışmamızın amacı hastanemizde dokuz yıllık süreçte tanı alan beyin ölümü olgularını inceleyerek beyin ölümü nedenlerini araştırmak, tanı alma sürecindeki testleri ve kadavradan organ nakil oranını incelemektir. İkincil amacımız beyin ölümü tanı konma süresinin bağış oranına etkisini araştırmaktır. Yöntemler: Etik Kurul onayı alınarak 1 Ocak 2004 ve 1 Ocak 2013 tarihleri arasında hastanemiz yoğun bakım ünitesinde beyin ölümü tanısı alan hastalar retrospektif olarak incelendi. Hastaların yaşı, beyin ölümü tanısında uygulanan testler, hastaneye gelişten beyin ölümü tanısı alana kadar geçen süre, tanı sonrası hastaların sağkalım süresi, ailelerin organ bağışına onay verip vermemeleri ve organ nakil oranları incelendi. Bulgular: Altmış hasta beyin ölümü tanısı aldı, 21’i (%35) kadın, 39’u (%65) erkekti. Ortalama yaş 28’di. Sadece 6 (%10) aile organ bağışı için onay verdi. Beyin ölümünün en sık nedeni travmatik beyin hasarı (37; %65) olarak bulundu. Beyin ölümü klinik testlerin yanı sıra 36 (%60) hastaya internal karotis dopler, 14 (%23) hastaya serebral anjiyografi, 2 hastaya da elektroensefalografi yapılarak tanı konuldu. Hastaneye geliş ile tanı konmasına dek geçen süre ortalama 5,16±3,06 gün; donör grubunda 2,0±0,4 gün, donör olmayan grupta 5,5±0,4 gün olarak bulundu. Tanıdan kardiyak ölüme dek geçen süre donör olmayan grupta 2,4±0,3 gün olarak bulundu. Tanı konduktan sonra donör grubunda organ nakline kadar geçen süre 1,08±0,2 gündü. Sonuç: Hastanemizde beyin ölümü sonrası organ bağış oranı oldukça düşük bulundu. Potansiyel donörlerin erken fark edilmesi ile organ bağış oranı artışı arasında istatistiksel anlamlı fark tespit edildi. Beyin ölümü tanısının erken konulması organ bağış oranını yükselterek nakil sırası bekleyen hastalar için umut ışığı olacaktır.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Pestana AL, dos Santos JL, Erdmann RH, da Silva EL, Erdmann AL. Lean thinking and brain-dead patient assistance in the organ donation process. Re Rev Esc Enferm USP 2013; 47: 258-64.
- 2. 2. IÜ/İzleme ve Değerlendirme Birimi, Sayılarla TTDİS. Nakil Bekleyen Hasta Sayıları October 2019;10 (cited: 01/01/2019) Available from: URL: https:// organ.saglik.gov.tr/ContentView.aspx?q=1
- 3. Eira CSLD, Barros MIT, Albuquerque AMP. Organ donation: the reality of an intensive care unit in Portugal. Rev Bras Ter Intensiva 2018; 30: 201-7.
- 4. Karasu D, Yılmaz C, Karaduman İ, Çınar YS, Buyukkoyuncu Pekel N. Retrospective analysis of brain death cases. Yoğun Bakım Journal 2015; 6: 23-6.
- 5. Battal M, Horoz A, Karatepe O, Çitgez, B. Beyin ölümü tespitinde araştırma hastanesi deneyimi. Şişli Etfal Hastanesi Tıp Bülteni 2013; 47: 59-62.
- 6. Mutlu, NM, Peker TT, Acar S, Koca B, Soyal ÖB, Titiz AP, et al. Brain Deaths and Donors in an Education and Research Hospital.” Transplantation proceedings. Elsevier 2019; 51: 2176-9.
- 7. International Registry in Organ Donation and Transplantation. Turkey Deceased Organ Donor Evolution June 2019 (cited :01/07/2019) Available from: URL: http://www.irodat.org/?p=database&c=TR#data
- 8. Kıraklı C, Uçar ZZ, Anıl AB, Özbek İ. The effect of shortening the definitive diagnosis time on the organ donation rates in the intensive care unit, Yoğun Bakım Journal 2011; 1: 8-11.
- 9. Özmert S, Sever F, Ayar G, Yazıcı MU, Öztaş DK. Brain Death and Organ Donation in Paediatric Intensive Care Unit.» Turk J Anaesthesiol Reanim 2019; 47: 55-61.
- 10. Oczkowski SJ, Durepos P, Centofanti J, Arsenau E, Dhanani S, Cook DJ, et al. Multidisciplinary Survey to Assess Facilitators and Barriers to Successful Organ Donation in the Intensive Care Unit. Prog Transplant 2019; 29: 179-84.
- 11. Gündüz RC, Sahin S, Uysal-Yazıcı M, Ayar G, Yakut HI, Akman AÖ, et al. Brain death and organ donation of children. Turk J Pediatr 2014; 56: 597.
- 12. Tsai E, Shemie SD, Cox PN, Furst S, McCarthy L, Hebert D. Organ donation in children: role of the pediatric intensive care unit.” Pediatr Crit Care Med 2000; 1: 156-60.
- 13. George S, Thomas M, Ibrahim EH, Abdussalam A, Chandra P, Ali HS, et al. Somatic survival and organ donation among brain-dead patients in the state of Qatar.” BMC Neurol 2016; 16: 207.
- 14. Tepehan S, Elmas İ. Türkiye’de Beyin Ölümü Tanısına Güven Sorunu ve Organ Bağışına Yansımaları. Yoğun Bakım Hemşireliği Dergisi 2014, 18.1: 8-14.
- 15. Girlanda R. Deceased organ donation for transplantation: Challenges and opportunities. World J Transplant 2016; 6: 451-9.
- 16. McCallum, J, Ellis, B, Dhanani S, Stiell, IG. Solid organ donation from the emergency department–A systematic review. CJEM 2019; 21: 626-637.
- 17. Koçak Süren S. Organ ve doku naklinin yasal ve etik açıdan incelenmesi. Türkiye Barolar Birliği Dergisi 2007; 73: 174-95
- 18. 18. Rithalia A, McDaid, C, Suekarran S, Myers L, Sowden A. Impact of presumed consent for organ donation on donation rates: a systematic review. BMJ 2009; 338: a3162.
- 19. English V, Johnson E, Sadler BL, Sadler AM. Is an opt-out system likely to increase organ donation?. BMJ 2019; 364: l967.
| APA | YENIOCAK T, Ergin Ozcan P (2020). Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study. , 115 - 119. 10.4274/imj.galenos.2020.71463 |
| Chicago | YENIOCAK TUGCE,Ergin Ozcan Perihan Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study. (2020): 115 - 119. 10.4274/imj.galenos.2020.71463 |
| MLA | YENIOCAK TUGCE,Ergin Ozcan Perihan Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study. , 2020, ss.115 - 119. 10.4274/imj.galenos.2020.71463 |
| AMA | YENIOCAK T,Ergin Ozcan P Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study. . 2020; 115 - 119. 10.4274/imj.galenos.2020.71463 |
| Vancouver | YENIOCAK T,Ergin Ozcan P Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study. . 2020; 115 - 119. 10.4274/imj.galenos.2020.71463 |
| IEEE | YENIOCAK T,Ergin Ozcan P "Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study." , ss.115 - 119, 2020. 10.4274/imj.galenos.2020.71463 |
| ISNAD | YENIOCAK, TUGCE - Ergin Ozcan, Perihan. "Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study". (2020), 115-119. https://doi.org/10.4274/imj.galenos.2020.71463 |
| APA | YENIOCAK T, Ergin Ozcan P (2020). Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study. İstanbul Medical Journal, 21(2), 115 - 119. 10.4274/imj.galenos.2020.71463 |
| Chicago | YENIOCAK TUGCE,Ergin Ozcan Perihan Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study. İstanbul Medical Journal 21, no.2 (2020): 115 - 119. 10.4274/imj.galenos.2020.71463 |
| MLA | YENIOCAK TUGCE,Ergin Ozcan Perihan Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study. İstanbul Medical Journal, vol.21, no.2, 2020, ss.115 - 119. 10.4274/imj.galenos.2020.71463 |
| AMA | YENIOCAK T,Ergin Ozcan P Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study. İstanbul Medical Journal. 2020; 21(2): 115 - 119. 10.4274/imj.galenos.2020.71463 |
| Vancouver | YENIOCAK T,Ergin Ozcan P Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study. İstanbul Medical Journal. 2020; 21(2): 115 - 119. 10.4274/imj.galenos.2020.71463 |
| IEEE | YENIOCAK T,Ergin Ozcan P "Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study." İstanbul Medical Journal, 21, ss.115 - 119, 2020. 10.4274/imj.galenos.2020.71463 |
| ISNAD | YENIOCAK, TUGCE - Ergin Ozcan, Perihan. "Brain Death and Deceased Organ Donation in a Hospital in İstanbul, Turkey: The Effect of Early Identification of Brain Dead on Organ Donation Rates: A Retrospective Study". İstanbul Medical Journal 21/2 (2020), 115-119. https://doi.org/10.4274/imj.galenos.2020.71463 |
