Brain death and postmortem organ donation: report of a questionnaire from the CENTER-TBI study

Brain death and postmortem organ donation: report of a questionnaire from the CENTER-TBI study Ernest van Veen¹,²,³, Mathieu van der Jagt¹, Maryse C. Cnossen², Andrew I. R. Maas⁴, Inez D. de Beaufort³, David K. Menon⁵, Giuseppe Citerio⁶,⁷, Nino Stocchetti⁸,⁹, Wim J. R. Rietdijk¹, Jeroen T. J. M. van Dijck¹⁰, Erwin J. O. Kompanje¹,³* and CENTER-TBI investigators and participants Abstract Background: We aimed to investigate the extent of the agreement on practices around brain death and postmortem organ donation. Methods: Investigators from 67 Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study centers completed several questionnaires (response rate: 99%). Results: Regarding practices around brain death, we found agreement on the clinical evaluation (prerequisites and neurological assessment) for brain death determination (BDD) in 100% of the centers. However, ancillary tests were required for BDD in 64% of the centers. BDD for nondonor patients was deemed mandatory in 18% of the centers before withdrawing life-sustaining measures (LSM). Also, practices around postmortem organ donation varied. Organ donation after circulatory arrest was forbidden in 45% of the centers. When withdrawal of LSM was contemplated, in 67% of centers the patients with a ventricular drain in situ had this removed, either sometimes or all of the time. Conclusions: This study showed both agreement and some regional differences regarding practices around brain death and postmortem organ donation. We hope our results help quantify and understand potential differences, and provide impetus for current dialogs toward further harmonization of practices around brain death and postmortem organ donation. Keywords: Traumatic brain injury, Brain death, Ethics, Postmortem organ donation, Withdrawing life-sustaining measures, Ventricular drainage