Prediction of possible brain death donors among patients who died due to spontaneous intracerebral hemorrhage

Abstract

Background: The rate of brain death organ donation is continuously increasing worldwide. Intracerebral hemorrhage (ICH) is the leading cause of brain death and accounts for 30-68% of organ transplant cases. Aim: To identify the predictors of brain death (BD) upon admission to the intensive care unit (ICU) of comatose patients with spontaneous intracerebral hemorrhage (ICH). Materials and methods: A prospective observational study was conducted on ICH deaths in the Stroke Department of Third State Central Hospital from January 1 to December 31, 2018, and statistical analysis was performed using SPSS 22.0. Approval for the study was obtained from the Research Council of the Third State Central Hospital. Results: The study included 138 (13.1%) inpatient stroke deaths in the Stroke Unit, of which 90 were ICH, 30 subarachnoid hemorrhage, and 18 ischemic strokes (p=0.006). Considering the age limit of up to 70 years, which is the criterion for brain-dead donors in Mongolia, out of the 42 ICH cases, 24 (57.1%) were male, and 18 (42.9%) were female (p=0.326). The mean age of these cases was 52.88±7.34, the mean GCS score at the time of hospitalization was 4.55±2.56, the mean NIHSS score was 31.5±7.81, and the mean volume of hematoma formed in 30 cases was 175.92±169.96 cm3 (each p<0.05). Mechanical ventilation durations occurred mostly in the first 0-2 hours and 2-6 hours (31% each), with the longest duration at 6-12 hours. Conclusion: Patients with ICH who present with poor mental status on hospital admission (GCS<7), severe stroke on clinical assessment (NIHSS>32), extensive cerebral hemorrhage on computed tomography (CT) imaging, and early requirement for mechanical ventilation have a high likelihood of progression to brain death. These patients therefore represent a significant potential pool of organ donors.