Anti-infective management in brain-dead organ donors – A retrospective analysis at two centers reveals need for improvement

Background

Adequate donor management is essential to increase the number of transplantable organs. No specific recommendations about anti-infective management for organ donors are available and the sparse literature indicates that antimicrobials are used too liberally. We analyzed anti-infective management of brain-dead donors to add to the limited evidence.

Methods

All brain-dead donors at the University Hospitals Münster (2010–2024) and Bielefeld Bethel (2020–2024) were retrospectively included. The use and indication of antimicrobials, microbiological diagnostics and inflammatory markers were assessed during intensive care unit stay and organ retrieval.

Results

149 donors were included, 76.5 % received antimicrobials in the intensive care unit and 21.5 % during organ retrieval. Antimicrobial exposure did not correlate between both periods. Indication for antimicrobials was documented in 61 % of donors, with aspiration pneumonia (33 %) and ventilator-associated pneumonia (33 %) being the most common diagnoses. Positive microbiological cultures were found in 36 % of donors but without correlation to antimicrobial exposure or length of exposure. The proportion of donors with out of normal range values for C-reactive protein (67–100 %), white blood cell count (53–88 %) and procalcitonin (22–43 %) was high, but only C-reactive protein differed between the day before and the day of brain death diagnosis and between infected and non-infected donors.

Conclusion

Antimicrobial use was high during intensive care unit stay, low during organ retrieval and inconsistent between both periods. Inflammatory markers were insufficient to indicate infection. Aggravated by a lack of evidence-based recommendations, this indicates inadequate anti-infective management of DBD donors, which may have a negative impact on the organ recipient.