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* From the Departments of Medicine, University of Toronto, Toronto;
Critical Care Medicine, University of Calgary, Calgary;
Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec;
Neurology, Montreal Neurological Institute, McGill University, Montreal, Quebec; and
¶ Emergency Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada.
Address correspondence to: Dr. Dan Cass, Emergency Medicine, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. E-mail: cassd{at}smh.toronto.on.ca This study was supported by a grant from the Clarica Corporation.
Purpose: Eleven hospitals in Ontario are adult neurosurgical centres (ONCs). Patients transferred to ONCs from community hospitals with acute intracranial emergencies often have non-survivable injuries, and may be returned to the referring hospital for end-of-life care. These referring hospitals may not be familiar with neurological determination of death, or organ donation. Our objective was to determine the number of patients with severe brain injuries assessed in ONC emergency departments where progression to brain death may be reasonably expected, and to determine their outcome.
Methods: A one-year retrospective cohort study was undertaken using a convenience sample of patients transferred to eight ONCs for neurosurgical assessment, with evidence of either (a) brain death in the emergency department, or (b) severe brain injury who met criteria of a reasonable likelihood of progression to brain death. The outcome of these patients to disposition from the ONC was determined by chart review.
Results: Three thousand four hundred and forty-seven patients were identified of whom 141 met inclusion criteria. Eleven patients (7.8%) were pronounced dead in the emergency department, 96 (68.1%) patients were admitted, and 34 (24.1%) were transferred back to their referring hospital. Fourteen patients (9.9%) became organ donors: two died in the emergency department and 12 died following admission.
Conclusions: A significant number of patients transferred to ONCs have an injury with a likelihood of progressing to brain death, but only a small proportion of these patients become organ donors. Emergency department triage, assessment and admission decisions for patients with intracranial catastrophes should consider diagnostic criteria for brain death and recognition of donor potential as part of end-of-life care.
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  S. D. Shemie Brain arrest to neurological determination of death to organ utilization: the evolution of hospital-based organ donation strategies in Canada/De l'arret cerebral a la determination neurologique de la mort et a l'utilisation d'organes : l'evolution du don d'organes en milieu hospitalier au Canada. Can J Anesth, August 1, 2006; 53(8): 747 - 752. [Full Text] [PDF]
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G. M. Rocker, D. J. Cook, and S. D Shemie Brief review: Practice variation in end of life care in the ICU: implications for patients with severe brain injury: [Revue sommaire de la variation des soins aux mourants dans les USI : implications pour les patients atteints de lesion cerebrale severe]. Can J Anesth, August 1, 2006; 53(8): 814 - 819. [Abstract] [Full Text] [PDF]
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