New Tool Predicts Candidates for Organ Donation

A new study helps clinicians predict the time of death following withdrawal of life-sustaining measures (WLSM), and could have a significant impact on rates of organ donation following death.

Researchers at the Mayo Clinic (Rochester, MN, USA) analyzed information from 149 people in a state of coma in a neurologic intensive care unit (ICU) whose life support was withdrawn; the most frequent diagnoses of these patients were ischemic stroke (30%) and intraparenchymal hemorrhage (52%). Individuals who died within 60 minutes were compared to those who died beyond this time. Patients who were not intubated, declared brain dead, and cases with insufficient data were excluded. Demographic, clinical, laboratory, and radiographic data were reviewed. The researchers succeeded in identifying four clinical factors related to an earlier time of death: no corneal reflex, no cough reflex, no motor or extensor response, and high scores on oxygenation index.

The researchers found that patients with all of these factors were 93% more likely to die within an hour of WLSM than people with none of these factors; those with one of the four factors were 65% to 76% more likely to die within the hour. The four factors, according to the researchers, could thus determine whether a person with irreversible brain damage would have a high likelihood of early death after life support is withdrawn, and thus serve as suitable for organ donation. The study was published in the April 27, 2010, issue of Neurology.

"Neurologists must often predict whether the patient will be a candidate, but the existing tools are not designed for people with critical brain disease or they require the patient to be taken temporarily off ventilator support to conduct the test,” said lead author Alan Yee, M.D., D.O., of the department of neurology.

Organ donation is a race against the clock once the heart stops beating. As such, death beyond one hour after withdrawal of life support often leads to donor ineligibility due to potential organ compromise, and is estimated to occur in up to 20% of potential cases.

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