Death, Brain
Conditions
Brief summary
Solid organ transplantation is the treatment of choice for end stage organ failure to improve patients' quality of life and survival. Each year, more than 5,000 solid organ transplants are performed in France, mainly from brain death donors (BDD). Approximately 1,500 BDD donors have one or more organs removed each year. Despite the growing demand for transplanted organs, the number of organs available from deceased donors has remained stable over the past few decades. This highlights the need to optimize the management of potential BDD, in order to increase both the quality and number of transplanted organs. Several studies have found an association between the characteristics and management of BDD donors and the number of organs, or even the function of transplanted organs. Data suggest that hemodynamic, respiratory, and metabolic therapeutic targets during BDD management prior to multi-organ procurement were associated with a higher number of transplanted organs compared to standard care. However, this has never been confirmed in a French population. Furthermore, while the impact of these therapeutic goals has been studied after the donor is in a state of brain death, the events occurring in the ICU before reaching brain death status and their impact on the number of organs retrieved have not been investigated. Lastly, the intensity of the therapeutic interventions used to achieve these goals, and certain management delays, have only been partially studied. Our hypothesis is that achieving a bundle of therapeutic goals, and the intensity of the interventions used to reach these goals, both before and after BDD, are associated with a greater number of organs retrieved.
Interventions
OTHERNo interventtion
to enhance the understanding of the factors associated with the number of organs retrieved from patients admitted to the ICU for organ donation
Sponsors
Société Française d'Anesthésie et de Réanimation
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients over 18 years of age, hospitalized in the ICU * In a state of brain death * No objection to organ donation during their lifetime * Patients with social security coverage
Exclusion criteria
* Objection to the use of their data during their lifetime * Registration in the national refusal registry
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Arterial pH | Between admission to intensive care and brain death and before multi-organ retrieval | Arterial pH between 7.3 and 7.5 |
| PaO2/FiO2 | Between admission to intensive care and brain death and before multi-organ retrieval | PaO2/FiO2 ≥ 300 |
| Central venous pressure | Within 7 last days before brain death and before multi-organ retrieval | Central venous pressure (CVP) between 4 and 12 mmHg |
| Left ventricular ejection fraction | Between admission to intensive care and brain death and before multi-organ retrieval | Left ventricular ejection fraction (LVEF) ≥ 50% |
| Sodium levels | Between admission to intensive care and brain death and before multi-organ retrieval | Sodium levels ≤ 155 mmol/L |
| vasopressor | Between admission to intensive care and brain death and before multi-organ retrieval | Low doses and a single vasopressor. (≤10 µg/kg/min of dopamine or ≤60 µg/min of Neosynephrine or ≤10 µg/min of norepinephrine)) |
| Mean arterial pressure | Between admission to intensive care and brain death and before multi-organ retrieval | Mean arterial pressure (MAP) between 60 and 110 mmHg |
| Diuresis | Between admission to intensive care and brain death and before multi-organ retrieval | Diuresis ≥ 0.5 mL/kg/h |
| Blood glucose | Between admission to intensive care and brain death and before multi-organ retrieval | Blood glucose ≤ 1.5 g/L |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number and nature of organs retrieved | Between admission to intensive care and brain death and before multi-organ retrieval | Describe the number and nature of organs retrieved, including heart, lungs (2 organs), kidneys (2 organs), liver, pancreas |
| Number, causes, and associated factors of unsuccessful organ retrieval procedures | Between admission to intensive care and brain death and before multi-organ retrieval | Desctibe the number, causes, and associated factors of unsuccessful organ retrieval procedures |
| Number of organs placed on ex situ preservation and the type of preservation method used | Between admission to intensive care and brain death and before multi-organ retrieval | Describe the number of organs placed on ex situ preservation and the type of preservation method used |
| Number and nature of organs available for transplantation | Between admission to intensive care and brain death and before multi-organ retrieval | Describe the number and nature of organs available for transplantation, including heart, lungs (2 organs), kidneys (2 organs), liver, pancreas |
| demographics of Brain dead | Between admission to intensive care and brain death and before multi-organ retrieval | The demographics of Brain dead |
| Causes of neurological injury leading to brain death | Between admission to intensive care and brain death and before multi-organ retrieval | Describe the causes of neurological injury leading to brain death |
| Timelines and durations of patient management before and after brain death | Between admission to intensive care and brain death and before multi-organ retrieval | Descibe the timelines and durations of patient management before and after brain death |
| Incidence of organ failures before and after brain death | Between admission to intensive care and brain death and before multi-organ retrieval | Describe the incidence of organ failures before and after brain death |
| Incidence of acute kidney failure before and after brain death | Between admission to intensive care and brain death and before multi-organ retrieval | Describe the incidence of acute kidney failure before and after brain death |
| Incidence of infections, sepsis, and septic shock before and after brain death | Between admission to intensive care and brain death and before multi-organ retrieval | Describe the incidence of infections, sepsis, and septic shock before and after brain death |
| Incidence of diabetes insipidus | Between admission to intensive care and brain death and before multi-organ retrieval | Describe the incidence of diabetes insipidus |
| Treatments administered before and after brain death | Between admission to intensive care and brain death and before multi-organ retrieval | Describe the treatments administered before and after brain death |
Countries
France
Contacts
Primary ContactMaxime COUTROT, MD
Backup ContactFrançois DEPRET, MD
Outcome results
None listed