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Francesco Procaccio Italy - Monday 28 - ICU and Organ Donation
1. Silent Brain Death The problem of donor identification. F Procaccio , L Rizzato, A Ricci, A Nanni Costa Italian Transplant National Centre Rome - Italy ISODP - Buenos Aires 2011
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4. Italian Regions – 2010 vs 2011 * preliminary data August 31, 2011 Declared BD p.m.p. 20 p.m.p. 80 p.m.p.
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6. Indicators : Potential of donation Brain Death declarations PROC 2 = ------------------ % Deaths with Acute Cerebral Lesions in ICU Benchmarking 50-65 %
12. Italian Registry – DACL in ICU Age Actual Donors Deaths with cerebral lesion Brain Deaths The “ silent ” BD vs Age F Procaccio et al. Transplant Proc, 2010
13. Deaths with ACL in ICU Age vs BD declaration vs Donors BD declared AGE DONORS
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15. Deaths with ACL In ICU vs BD Declaration 391 DLCA 128 BDs 33% range 17/22 ( 77 %) 26/50 ( 52 %) 7/50 ( 14 %) Deaths With Acute Cerebral Lesion 4 ICUS around 50 5 ICUs 20-40 7 ICUs 1-10 16 ICUs Region x BD DACL DACL BD ICUs
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17. ICU DDC The ICU Donation Champions & the Deceased Donor Coordination Tx Hospital
19. en sciene & en route Aggressive treatment circulation ventilation ICP control Max treatment Organs Brain All they need is flow recovery Brain Death Organ Donor
20. Transplant Proc, 2010 As neurointensive treatment can improve outcomes and reduce “silent” BDs, more DBD donors exist where patients with acute cerebral lesion are better treated.
21. Do enhance ICU’s SKills & Motivation Research Recognition in organ donation
![POTENTIAL DBD DONOR A person w hose clinical condition is suspected to fulfill brain death criteria. ELIGIBLE DBD DONOR A medically suitable person who has been declared dead based on neurologic criteria as stipulated by the law of the relevant jurisdiction. Critical pathways for organ donation * POSSIBLE DECEASED ORGAN DONOR A patient with a devastating brain injury or lesion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Donation after BrainDeath ( DBD ) Treating physician to identify/refer a potential donor * The “dead donor rule” must be respected . That is, patients may only become donors after death, and the recovery of organs must not cause a donor’s death . ,[object Object],[object Object],[object Object],[object Object],[object Object],UTILIZED DBD DONOR An actual donor from whom at least one organ was transplanted. Donation after Circulatory Death ( DCD )](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)