Evaluation of patients diagnosed with brain death in the intensive care unit: 10 years of tertiary center experience in Istanbul

OBJECTIVE: Early and accurate diagnosis of brain death in intensive care units (ICU) is essential for organ transplantation.
This study aimed to evaluate the cases diagnosed with brain death in the ICU of a tertiary center in Istanbul.
METHODS: The cases diagnosed as brain death in the ICU during the ten years between January 2013 and September 2022 were evaluated retrospectively. The demographic characteristics of the patients, the diagnosis of hospitalization in the ICU, the time from arrival to the ICU until the diagnosis of brain death, the somatic survival time after the diagnosis of brain death, the acceptance rate of organ donation by the families and the organs removed were evaluated.
RESULTS: A total of 44 patients were diagnosed with brain death. The mean age of the cases was 39.7±17.4 years, and 63% were male. The most common hospitalization diagnosis was intracranial hemorrhage (81.8%). Traffic accidents, hypertensive and aneurysm-related hemorrhages, gunshot wounds, and falls from height were the most common causes of intracranial hemorrhage. Patients were admitted to the ICU most frequently from the emergency department (54%). The mean time to brain death was 7.9±6.2 days, and the somatic survival time was 1.9±1.9 days in patients who did not receive organ transplantation. While the apnea test was positive in 91% of the cases, the apnea test could not be completed in 9% of the cases. While relatives of 7% (n=3) of the cases accepted organ donation, a patient was not allowed to be an organ donor for medical reasons. Organ transplantation was performed in two patients (5%).
CONCLUSION: As in the whole world, getting treatment as soon as possible for the patients waiting on the organ transplant list in Turkiye by increasing the number of organs to be obtained from cadavers. In cases with suspected brain death in the ICU, diagnosing brain death as soon as possible and conducting family interviews with trained organ transplant coordinators will increase the number of cadaver donors. However, we think policies should be developed to ensure that society is informed and encouraged about brain death and organ donation.

Yoðun bakým ünitesinde beyin ölümü tanýsý konulan hastalarýn deðerlendirilmesi: Ýstanbul’da 10 yýllýk tersiyer merkez deneyimi

GÝRÝÞ: Yoðun bakým ünitelerinde (YBÜ) beyin ölümü tanýsýnýn erken ve doðru þekilde konulmasý organ nakli için son derece önemlidir. Bu çalýþmada Ýstanbul’da tersiyer bir merkezin YBÜ’sinde beyin ölümü tanýsý konulan olgularýnýn deðerlendirilmesi amaçlanmýþtýr.
METOD: Ocak 2013-Eylül 2022 arasýndaki 10 yýllýk süreçte YBÜ’de beyin ölümü tanýsý konulan olgular retrospektif olarak deðerlendirildi. Hastalarýn demografik özellikleri, YBÜ’sine yatýþ tanýlarý, YBÜ’ne geliþinden beyin ölümü tanýsý konulana kadar geçen süreler, beyin ölümü tanýsý sonrasýndaki somatik sað kalým süreleri, ailelerin organ baðýþýný kabul/ret oranlarý ile çýkarýlan organlar deðerlendirilmiþtir.
BULGULAR: Toplam 44 hastaya beyin ölümü tanýsý konuldu. Olgularýn ortalama yaþý 39.7±17.4 ve %63’ü erkek idi. En sýk yatýþ tanýsý intrakranyal hemoraji (%81.8) idi. Trafik kazalarý, hipertansif ve anevrizmaya baðlý kanamalar, ateþli silah yaralanmalarý, yüksekten düþmeler en sýk intrakranyal kanama sebepleri idi. Hastalar en sýk acil servisten (%54) YBÜ’ne kabul edildi. Ortalama beyin ölümü gerçekleþme süresi 7.9±6.2 gün, organ nakli gerçekleþmeyen olgularda somatik sað kalým süresi 1.9±1.9 gün idi. Olgularýn %91’inde apne testi pozitif tespit edilirken, %9’unda apne testi tamamlanamadý. Olgularýn %7’sinin (n: 3) yakýný organ baðýþýný kabul ederken bir hastanýn organ donörü olmasýna týbbi nedenlerle izin verilmedi. Ýki hastadan (%5) organ nakli gerçekleþtirildi.
SONUÇ: Tüm dünyada olduðu gibi Türkiye’de de organ nakil listesinde bekleyen hastalarýn en kýsa sürede tedavi olabilmeleri, kadavradan temin edilecek olan organ sayýsýnýn artýrýlmasý ile mümkündür. YBÜ’de beyin ölümü þüphesi olan olgularda en kýsa sürede beyin ölümü tanýsýnýn konulmasý ve eðitimli organ nakil koordinatörleri ile aile görüþmeleri yapýlmasý kadavradan donör temin sayýsýný artýracaktýr. Bununla birlikte toplumun beyin ölümü ve organ baðýþý konusunda bilgilendirilerek teþvik edilmesini saðlayacak politikalar geliþtirilmesi gerektiðini düþünüyoruz. (NCI-2022-10-6)