Assessment for Harmful Results of Apnea Test to Brain-death Patients and Impact on Organ Donation - การประเมินอันตรายของ การทดสอบการไม่หายใจในผู้ป่วยสมองตาย และผลกระทบต่อการบริจาคอวัยวะ

Abstract

         Epidemiological and demographic figures of brain-death donors in Thailand are quite low compared to some other countries. Barriers to brain-death organ donation are multifactorial. One major reason is the diagnosis of brain-death which includes the utilization of apnea test. Most medical personnel did not realize that “brain-death” is “death”, and they worried that the apnea test might be harmful to brain-death patients. When they denied to operate apnea test, procedures for organ donation could not be done. These professional attitudes and legal environment were the underlying reasons for the small numbers of braindeath donors in Thailand, e.g. 2.9 donors to one million population compared to 33.0-35.0 donors to one
million population in Spain. The objective of this study was to assess the harmful results of apnea test in order to promote the test for the confirmation of death which would be beneficial for convincing health persinnel to proceed with organ donation in patients with brain deaths. This study was designed as a prospective observational study in Lerdsin and Bahn-paew Hospitals during 2011-2014. Twenty-seven brain death patients were included in the study. They were operated for “apnea test” strictly follow the standard of Thai Medical Council and Thai Red Cross Organ Donation Center. Data monitoring included apnea test procedures, pathophysiological changes of the patients and decision making for organ donation by their families. There was only one case with minor complication that PaO2 was 52 mmHg (hypoxia), immediately correction resulted in normal heart beating and blood pressure. The patient became donor eventually. Ratio of organ donation in this study was 70.4 percent. The study demonstrated that “Apnea Test for brain-death donor” would not be harmful for patient when the operation had been performed based on standard guildlines. Apnea test should be recommended in most potential brain-death donors to raise numbers of organ donation for transplantation
Key words: apnea test, brain-death donor, organ donation