Donation After Brain Death: Are There Any Organizational Difficulties?

Abstract

Objectives: In the past 3 years, nearly 90 % of organ transplants performed in our country have been from living donors. Low rates of organ donation and family consent in cases of brain death reduce the source of deceased donors. Here, we reported the challenges of determination of brain death and donor care processes in our hospital and offered our recommendations to strengthen these services.

Materials and methods: We retrospectively analyzed adult patients (n = 5845 )treated in adult intensive care units of Manisa City Hospital from June 1, 2024, through November 30, 2025. Demographic information and clinical data were collected for patients diagnosed with brain death (n = 10 ), including time from admission to brain death determination, time from brain death determination to cardiac arrest, and time from first evaluation to brain death. We also collected data on organ donation and the reason for family donation refusal.

Results: The ratio of brain death cases to total patients was 0.17 %. The rate of deceased organ donation of brain death cases was 20 %. Time from first evaluation to brain death determination ranged between 7.3 and 169 hours. Time from brain death determination to cardiac arrest ranged between 4 and 91 hours. For brain death determination, apnea test was performed in 7 patients (70 % ). For all cases, ancillary tests were used. Four -vessel digital subtraction angiography was performed in 3 cases (30 % ). There were multidrug -resistant infections in 3 cases.

Conclusions: Medical knowledge and practices regarding organ donation and donor care after brain death should be raised to international standards. It remains important for transplant clinicians to increase cooperation between our Ministry of Health and hospital administrators for consideration of current scientific data to reduce organizational challenges. Such cooperative efforts could further strengthen organ transplant services, which are already quite successful in our country.