Evaluation of the time of diagnosis of brain deaths notified to the Center for Transplants of Rio Grande do Sul, Brazil
DOI:
https://doi.org/10.15448/1980-6108.2015.3.21328Keywords:
brain death, organ transplantation, tissue donors.Abstract
Aims: To evaluate how long it takes for the diagnosis of brain deaths notified to the Center for Transplants of Rio Grande do Sul, southern Brazil, and to establish a relationship between the time needed for the diagnosis and the harvest of organs and their transplantation.
Methods: The study included brain death notifications to the Center for Transplants of Rio Grande do Sul for donors from 2003 to 2013. Information about the donors (place of origin, age, complexion, sex, and cause of death), about the diagnosis of brain death (date and time of day at which the protocol was created, time of the first and second clinical tests, and time of complementary examination), and about the harvested and transplanted organs and tissues was collected. The means between groups were compared by Student’s t test and ANOVA or by their nonparametric counterparts, i.e., Mann-Whitney and Kruskal-Wallis tests.
Results: A total of 492 donors were included in the study, among whom 275 (55.9%) were male. There was a predominance of individuals aged 40 to 59 years (222 donors or 45.2%). Stroke was the main cause of death (276 or 56.1%), and CT angiography was the most widely used complementary exam, performed in 177 (36%) individuals. Kidneys were the most frequently harvested organs (968 or 98.4%), being transplanted in 910 (94%) cases. Heart was the least frequently harvested organ (35 or 7.1%), with a transplantation rate of 100%. The average time between the clinical tests and the determination of brain death amounted to 8.9 and 14.1 hours, respectively. Protocols initiated during the night which included magnetic resonance angiography and electroencephalogram presented a higher average time. No significant difference was observed between the time needed for brain death diagnosis and organ harvest and transplantation.
Conclusions: The overall average time between clinical tests for the diagnosis of brain death was greater than that recommended by the Brazilian National Medical Council. However, the average time for the diagnosis of brain death was not a determining factor for the number of harvested and transplanted organs.
Downloads
References
Garcia VD, Haussen SR, Piva MO, Comerlatto CB, Bonetto JHP, Wallauer MM, Santos BTMQ. O diagnóstico de morte encefálica. In: Garcia CD, Pereira JD, Zago M, Garcia VD. Manual de Doação e Transplantes. Rio de Janeiro: Elsevier; 2013. p. 69-85.
Mollaret P, Goulon M. Le coma Dépassé mémoire préliminaire. Rev Neurol (Paris). 1959 Jul;101:3-15.
A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA. 1968 Aug 5;205(6):337-40.
Conselho Federal de Medicina (BR). Resolução CFM 1.826 de 06 de dezembro de 2007. Dispõe sobre a legalidade e o caráter ético da suspensão dos procedimentos de suportes terapêuticos quando da determinação de morte encefálica de indivíduo não-doador. DOU. 2007;Seção I:133.
Meneses, EA, Souza, MFB, Baruzzi RM, Prado, MM, Garrafa V. Análise bioética do diagnóstico de morte encefálica e da doação de órgãos em hospital de referência do Distrito Federal. Rev Bioet. 2010;18(2):397–412.
Conselho Federal de Medicina (BR). Resolução CFM 1.346 de 8 de agosto de 1991. Define critérios para caracterização de morte cerebral. DOU [Internet]. 1991;Seção 1:22731. [cited 2014 Aug 10]. Available from: http://www.portalmedico.org.br/resolucoes/CFM/1991/1346_1991.htm
Morato EG. Morte encefálica : conceitos essenciais , diagnóstico e atualização. Rev Med Minas Gerais. 2009;19(3):227–36.
Conselho Federal de Medicina (BR). Resolução CFM 1.480, de 08 de agosto de 1997. Dispõe sobre a caracterização de morte encefálica [Internet]. Brasília; 1997. [cited 2014 Aug 10]. Available from: http://www.portalmedico.org.br/resolucoes/CFM/1997/1480_1997.htm
Associação Brasileira de Transplantes de Órgãos - ABTO. Registro Brasileiro de Transplantes [Internet]. São Paulo; 2014. [cited 2014 Aug 15]. Available from: http://www.abto.org.br/abtov03/Upload/file/RBT/2014/rbt2014-assoc.pdf
Secretaria de Saúde do Estado do Rio Grande do Sul. Resultados da Doação e Transplante no RS - 2013 [Internet]. [Porto Alegre]; 2013.[ cited 2014 Set 5]. Available from: http://www.saude.rs.gov.br/upload/1392644481_transplantesbalanco2013.pdf
Pimenta FDP, Rios B, Amorim V, Silva LJ. Morte encefálica : diagnóstico possível sem utilização de exames complementares. Arq Bras Neurocir. 2012;31(1):22–7.
Noronha MGO, Seter GB, Perini LD, Salles FMO, Nogara MAS.Gabriela M, Noronha. Estudo do perfil dos doadores elegíveis de órgãos e tecidos e motivos da não doação no Hospital Santa Isabel em Blumenau, SC. Rev AMRIGS. 2012;56(3):199–203.
Moraes EL, Silva LBB, Moraes TC, Paixão NCS, Izumi NMS, Guarino AJ. O Perfil de Potenciais Doadores de Órgãos e Tecidos. Rev Latinoam Enfermagem. 2009;17(5):716-20. http://dx.doi.org/10.1590/S0104-11692009000500019
Associação Brasileira de Transplante de Órgãos - ABTO. Registro Brasileiro de Transplantes [Internet]. São Paulo; 2013. [cited 2014 Set 15]. Available from: http://www.abto.org.br/abtov03/Upload/file/RBT/2013/rbt2013-parcial(1).pdf
Instituto Brasileiro de Geografia e Estatística. Grandes Regiões e Unidades de Federação: Esperança de vida ao nascer segundo projeção populacional: 1980, 1991-2030 - Ambos os sexos [Internet]. Rio de Janeiro; 2002. [cited 2015 Set 17]. Available from: http://www.ibge.gov.br/home/presidencia/noticias/imprensa/ppts/0000000243.pdf
Al-maslamani Y, Muhsin ASA, Ali OIM, Fadhil RA, Hadi A, Jeish RA. Potential Brain Death Organ Donors - Challenges and Prospects: A Single Center Retrospective Review. Saudi J Kidney Dis Transpl. 2014 May;25(3):589-96.
Pessoa JLE, Schirmer J, Roza, BA. Avaliação das causas de recusa familiar a doação de órgãos e tecidos. Acta Paul Enferm. 2013;26(4):323–30. http://dx.doi.org/10.1590/S0103-21002013000400005
Nozary Heshmati B, Ahmadi F, Azimi P, Tirgar N, Barzi F, Gatmiri SM. Hemodynamic Factors Affecting the Suitability of the Donated Heart and Kidney for Transplantation. Int J Organ Transplant Med. 2013;4(4):150-4.
Westphal GA, Caldeira Filho M, Vieira KD, Bartz MCM, Wanzuika R, Réa-Neto A, Teixeira C, Franke C, Machado FO, Andrade J, Matos JD, Gerent KB, Fiorelli A, Goncalves ARR, Ferraz Neto B, Dias FS, Carvalho FB, Costa G, Camargo JJ, Teles JMM, Nogara MM, Coelho ME, Mazzali M, Youssef NCM, Duarte P, Souza RL, Fernandes R, Camargo S, Garcia VD. Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido . Parte III . Recomendações órgãos específicas. Rev Bras Ter Intensiva. 2011;23(47):410-25.
Cinque VM, Bianchi ERF, Araújo EAC. The time involved for the confirmation of brain death. Rev Enferm UFPE Online [Internet]. 2009;3(3):504-10. [cited 2014 Dec 2]. Available from: http://www.ufpe.br/revistaenfermagem/index.php/revista/article/view/157/pdf_897
Nogueira EPC. Potencial Para obtenção de órgãos em um hospital de urgência de Sergipe. JBT. 2007;10:756–61.
Lustbader D, O'Hara D, Wijdicks EF, MacLean L, Tajik W, Ying A, Berg E, Goldstein M. Second brain death examination may negatively affect organ donation. Neurology. 2011 Jan 11;76(2):119-24. http://dx.doi.org/10.1212/WNL.0b013e3182061b0c
