Organ Donor Recognition: Practical and Ethical Considerations

The brain dead patient is the ideal multiorgan donor. Conditions that can lead to the state of brain death are limited. A subarachnoid haemorrhage, intracerebral haemorrhage or traumatic brain injury precede in 83% of the cases the state of brain death. Because of better prevention and treatment options of these conditions, we anticipate a further decline of brain death. Consequently, we have to evaluate other possibilities to obtain organs. The research questions of this thesis were how to improve organ donor recognition, how to increase family consent for organ donation, and if presumed consent is a realistic solution to solve the shortage of organs. To improve organ donor recognition we proposed a new definition of a potential organ donor based on a state we called ‘imminent brain death’. The definition of ‘imminent brain death’ was based on the Glasgow Coma Score and a new neurological assessment score, the FOUR score. We compared this new definition with results of the Organ and Procurement Transplantation Network (OPTN). We furthermore investigated the ethical basis to obtain consent for organ donation from consciousness patients of whom we withdraw futile therapy. Additionally we studied changes in the timing to initiate the discussion about organ donation with the relatives of a patient. The final study concerns the external validation of a prognostic model to predict the probability of death, of patients with a devastating neurological condition, within 60 minutes after the withdrawal of life sustaining measures.