Impact of catastrophic brain injury guidelines on organ donation rates: Results of an EAST multicenter trial

Authors

Kristen D. Nordham, Tulane University, New Orleans, LA
Danielle Tatum, Tulane University, New Orleans, LA
Abdallah S. Attia, Tulane University, New Orleans, LA
Mayur B. Patel, Vanderbilt University Medical Center, Nashville, TN
Anil Paramesh, Tulane University, New Orleans, LA
Juan C. Duchesne, Tulane University, New Orleans, LA
Jeffry Nahmias, University of California—Irvine, Orange, CA
Amelia W. Maiga, Vanderbilt University Medical Center, Nashville, TN
Allan B. Peetz, Vanderbilt University Medical Center, Nashville, TN
Pascal O. Udekwu, Wake Med, Raleigh, NC
Anquonette Stiles, Wake Med, Raleigh, NC
Chloe Shell, Wake Med, Raleigh, NC
Joshua D. Stodghill, Virginia Tech Carilion School of Medicine, Roanoke, VA
Taneen Maghsoudi, Virginia Tech Carilion School of Medicine, Roanoke, VA
Erin Iacullo, Tulane University, New Orleans, LA
Bryant McLafferty, Tulane University, New Orleans, LA
Erin Coonan, Tulane University, New Orleans, LA
Ryan M. Boudreau, LSU Health Sciences Center - New Orleans
Steven A. Zimmerman, LSU Health Sciences Center - New Orleans
Berje Shammassian, LSU Health Sciences Center - New Orleans
Tanya Egodage, Cooper Medical School of Rowan University, Camden, NJ
Isabella Aramento, Cooper Medical School of Rowan University, Camden, NJ
Patrick Morris, Cooper Medical School of Rowan University, Camden, NJ
Jacob Metheny, Cooper Medical School of Rowan University, Camden, NJ
Michael S. Farrell, Lehigh Valley Health Network, Allentown, PA
Matthew D. Painter, Lehigh Valley Health Network, Allentown, PA
Owen T. McCabe, Valleywise Health Medical Center, Phoenix, AZ
Philomene Spadafore, Valleywise Health Medical Center, Phoenix, AZ
Alison A. Smith, LSU Health Sciences Center - New OrleansFollow
et al

Document Type

Article

Publication Date

9-27-2024

Publication Title

The Journal of Trauma and Acute Care Surgery

Abstract

BACKGROUND: One third of organ donors suffer catastrophic brain injury (CBI). There are no standard guidelines for the management of traumatic CBI prior to brain death, and not all trauma centers have institutional CBI guidelines. In addition, there is high variability in management between institutions with guidelines. Catastrophic brain injury guidelines vary and may include various combinations of hormone therapy, vasopressors, fluid resuscitation, and other practices. We hypothesized that centers with CBI guidelines have higher organ donation rates than those without. METHODS: This prospective, observational EAST-sponsored multicenter trial included adult (18+ years old) traumatic-mechanism CBI patients at 33 level I and II trauma centers from January 2022 to May 2023. Catastrophic brain injury was defined as a brain injury causing loss of function above the brain stem and subsequent death. Cluster analysis with linear mixed-effects model including UNOS regions and hospital size by bed count was used to determine whether CBI guidelines are associated with organ donation. RESULTS: A total of 790 CBI patients were included in this analysis. In unadjusted comparison, CBI guideline centers had higher rates of organ donation and use of steroids, whole blood, and hormone therapy. In a linear mixed-effects model, CBI guidelines were not associated with organ donation. Registered organ donor status, steroid hormones, and vasopressin were associated with increased relative risk of donation. CONCLUSION: There is high variability in management of CBI, even at centers with CBI guidelines in place. While the use of institutional CBI guidelines was not associated with increased organ donation, guidelines in this study were not identical. Hormone replacement with steroids and vasopressin was associated with increased donation. Hormone resuscitation is a common feature of CBI guidelines. Further analysis of individual practices that increase organ donation after CBI may allow for more effective guidelines and an overall increase in donation to decrease the long waiting periods for organ transplant recipients. LEVEL OF EVIDENCE: Prognostic; Level III.

PubMed ID

39327646

Recommended Citation

Nordham, Kristen D.; Tatum, Danielle; Attia, Abdallah S.; Patel, Mayur B.; Paramesh, Anil; Duchesne, Juan C.; Nahmias, Jeffry; Maiga, Amelia W.; Peetz, Allan B.; Udekwu, Pascal O.; Stiles, Anquonette; Shell, Chloe; Stodghill, Joshua D.; Maghsoudi, Taneen; Iacullo, Erin; McLafferty, Bryant; Coonan, Erin; Boudreau, Ryan M.; Zimmerman, Steven A.; Shammassian, Berje; Egodage, Tanya; Aramento, Isabella; Morris, Patrick; Metheny, Jacob; Farrell, Michael S.; Painter, Matthew D.; McCabe, Owen T.; Spadafore, Philomene; Smith, Alison A.; and al, et, "Impact of catastrophic brain injury guidelines on organ donation rates: Results of an EAST multicenter trial" (2024). School of Medicine Faculty Publications. 3048.
https://digitalscholar.lsuhsc.edu/som_facpubs/3048
10.1097/TA.0000000000004386