Causes and follow-up outcomes of brain dead patients in Shahid Beheshti University of Medical Sciences hospitals

Brain death is an irreversible loss of brain and brainstem activities and these patients are the main organ donors. However, in Iran many families refuse to donate brain dead organs. Here, we report causes of brain death and the results of these patient's follow-up in Shahid Beheshti University Organ Procurement Unit (OPU).

This descriptive study was carried out in one of the organ procurement units of Tehran that covers one third of Tehran population in 2009-2010. Suspected brain dead patients were detected and evaluated for the signs of brain death and suitability of the organs. If the patient was a suitable donor, their family was approached by the coordinator and social workers. Upon family consent, the patient was transferred to the OPU ICU of Masih Daneshvari Hospital and the organs were retrieved after confirmation of brain death.

From 467 detected patients, 373 were diagnosed as brain dead. 29 patients (8%) were 15 y old or younger (mean: 10 y) and 344 were older (mean: 47 y). In both age groups car accident was the most common cause of brain death (55% and 33% in younger and older than 15y, respectively). Brain tumor was the second cause in younger and intracranial hemorrhage and CVA were the second and third causes in the other group. 184 patients had suitable organs and 160 families were approached. 117 (73%) of the families refused to donate. 2 patients died before donation and organ donation was carried out in 41 patient (26%). In spite of more suitable organs, family refusal was higher in traumatic patients (74%) compared with other causes of brain death. ‍

This study showed that the most common cause of brain death in both children and adults was trauma. Unfortunately, in spite of more suitable organs in traumatic patients, the rate of family refusal was dramatically high. Thus, improvement of society cultural level about brain death and organ donation is necessary.