Evaluation of Emergency Department Professionals' Knowledge and Attitudes Toward Approaching Brain Death and Potential Organ Donor Recognition: A Cross-Sectional Survey.

Abstract

Objectives: Early identification of potential organ donors is essential for expanding the donor pool. Although brain death is typically diagnosed in intensive care units, the recognition of patients with imminent brain death should begin earlier, particularly in the emergency department. In this study, we aimed to evaluate the knowledge and attitudes of emergency department professionals regarding brain death, with a specific focus on the early recognition of imminent brain death.

Materials and methods: This cross -sectional study was conducted among emergency department health care professionals. We used a structured questionnaire to assess participants' knowledge and attitudes on imminent brain death and potential donor recognition.

Results: Among 104 emergency department professionals who participated in the study, 82 participants (78.8 % ) considered brain death diagnosis medically reliable, but important knowledge gaps were identified. Only 42 participants (40.4% ) correctly identified the components of the FOUR score (eye response, motor response, brainstem reflexes, and respiration ), with residents showing significantly lower proficiency versus specialists (9.1 % vs 59.3 %; P < .001 ). Institutional training exposure was alarmingly low at 11.5 %, compared with much higher rates reported in other reports on intensive care. Only 18 participants (17.3 % ) were aware of an emergency department -specific protocol for severe brain injury, and only 22 participants (21.2 % ) reported early involvement of organ transplant coordinators. Prior experience in brain death declaration was a significant predictor of higher trust (83.3 % vs 77.5 %; P = .023 ) ) and protocol awareness (33.3 % vs 12.5 %; P = .049 ).

Conclusions: Emergency departments represent the first point of contact for patients who may progress to brain death. Recognition of imminent brain death must begin in the emergency department to enable timely identification and referral. Targeted training programs and the development of emergency department -focused protocols may improve early donor recognition and contribute to expanding the donor pool.