Detailed analysis of autopsy in brain death donation in Korea
Ki Dong Song1, Ji eun Min2, Yong min Lee3, Kyoung min Kim4, Hyunjin Kang5, Jeong rim Lee6, Insung Moon7.
1Department of Donor Management, Korea Organ Donation Agency, Seoul, Korea; 2Department of Donor Management, Korea Organ Donation Agency, Seoul, Korea; 3Department of Donor Management, Korea Organ Donation Agency, Seoul, Korea; 4Department of Donor Management, Korea Organ Donation Agency, Seoul, Korea; 5Department of Donor Management, Korea Organ Donation Agency, Seoul, Korea; 6Department of Donor Management, Korea Organ Donation Agency, Seoul, Korea; 7Department of Donor Management, Korea Organ Donation Agency, Seoul, Korea
Background: In Korea, in the case of an unnatural brain death donor who has agreed to donate organs, it can be proceeded only after obtaining approval from the examination before autopsy. If an autopsy is deemed necessary during the process, the donation procedure is stopped contrary to the intention of the donor and the bereaved family. Therefore, we would like to find out a way to respect the will of the noble family who decided to donate through the analysis of the brain death organ donor, which was discussed for autopsy from 2016 to 2021.
Method: From January 1, 2016 to December 31, 2021, among 1,437 exogenous brain death donors who agreed to donate organs, 51 patients for whom autopsy was discussed were analyzed.
Result: From 2016 to 2021, there were 2,907 brain death donors, of which 1,437 (49.4%) were unnatural death. As for diseases caused by external factors, 788 cases (54.8%) of head trauma, 645 cases (44.9%) of hypoxic brain injury, and 4 cases (0.3%) of other causes such as cerebral edema and brain lesions. There were 51 foreign donors for whom the necessity of autopsy was discussed, and 29 patients were subjected to autopsy after donation by judicial judgment, and 22 patients were donated without an autopsy. Of these, 22 donations were made through 15 supplementary investigations and 7 direct autopsies through visits to the prosecutor's office. The 51 deaths were 33 suspected crimes, 11 falls, 2 traffic accidents, 2 fire accidents, and 2 medical accidents. There was one case of asphyxiation from gas during operation.
Conclusion: From 2016 to 2021, 49.4% of brain fraud donors were foreigners, and patients with the need for autopsy among foreigners will continue to occur. Accordingly, it is necessary to find ways not to restrict "judicial procedures" and "brain death donation". It is believed that the role of the organ acquisition agency is to reflect the intention of the family who decided to donate through sharing cases that could be donated without interfering with the exact cause of death, such as initial intervention by forensic experts, conditional approval according to circumstances, and observation of donation surgery.
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