Brain death in Uruguay: 19 years of experience
Raul Mizraji1, Ana Castro1, Mario Godino1, Agustin Carambula1, Armando Caciatore1, Ana L Morales1, Cono Garcia1.
1Montevideo, Instituto Nacional de Donacion y Trasplantes, Montevideo, Uruguay; 2Montevideo, Instituto Nacional de Donacion y Trasplantes, Montevideo, Uruguay; 3Montevideo, Instituto Nacional de Donacion y Trasplantes, Montevideo, Uruguay; 4Montevideo, Instituto Nacional de Donacion y Trasplantes, Montevideo, Uruguay; 5Montevideo, Instituto Nacional de Donacion y Trasplantes, Montevideo, Uruguay; 6Montevideo, Instituto Nacional de Donacion y Trasplantes, Montevideo, Uruguay; 7Montevideo, Instituto Nacional de Donacion y Trasplantes, Montevideo, Uruguay
Objetive: Describe the Epidemiology of Brain Death (BD) in 19 years.
Material and methods: We studied potential donors reported to the National Registry of Donors diagnosed with BD between 2002 and 2020. We analyzed: total number of communications, age distribution, causes of death, BD diagnostic method, medical contraindications, family refusals, real donors and conversion of BD to real donor.
Results: They communicated 2770 BD from all over the country, the age distribution was mainly between 18 and 60 years old, representing 70%. In extreme ages we had the lowest percentage of diagnoses with 2.2% between 1 and 5 years and 2% in those older than 75 years. Taking globally those over 65 years of age, these were 10.1% of BD. There were no differences regarding the months of the year or the days of the week in which the BD were reported. The time of greatest communication was between 1:00 and 6:00 p.m., 36% and from 7:00 to 11:00 p.m. 23%. Causes of death: CVA 51.1% followed by TEC with 23.4%. The diagnosis of BD was clinical and Doppler was used in 20%. Doppler was used as an auxiliary method in 6.8% in 2019 and 9.2% in 2020. The medical contraindications were: sepsis 16%, poor hemodynamics 10.8%, tumor 12%, hypertension/diabetes 16%. The family refusal prior to the implementation of the presumed consent law was 54.4% and of the total communications of BD that had prior expression of donation in the National Registry of Donors, 46.7% were negative. The real donors in this period were 1125. Conversion from BD to Real Donor of 40%. Analyzing the conversion in the years following the implementation of presumed consent, the average conversion was 51.6% 860BD/444 DR. DR over 65 years old were 5.4%, 66 to 70 years old 4.1%, 71 to 75 years old 1.1% and over 75 years old 0.08%.
Conclusion: Uruguay has a rich experience in donation and transplants. This analysis of 19 years of BD communications leaves some important conclusions: a decrease in BD in children under 5 years of age, low use of people over 65 years of age as real donors, and a clear benefit of the presumed consent law over the refusal to The donation.
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