COVID-19 Pandemisinde Beyin Ölümü ve Organ Bağışı: Retrospektif Gözlemsel Çalışma

Amaç: COVİD-19 pandemisi dünya genelinde olduğu gibi ülkemizde de organ nakli süreçlerini etkilemiştir. Bu çalışma ile pandemi döneminde bölgedeki en büyük referans pandemi hastanesindeki beyin ölümü ve kadaverik organ donasyonu olgularının değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: 11.3.2020-11.3.2021 tarihleri arasında hastanemizde tanı koyulan tüm beyin ölümü olguları retrospektif olarak değerlendirilmiştir. Demografik özellikler, aile onay oranları ve COVID-19 ekartasyonu açısından yapılan ek değerlendirmeler dahil olmak üzere hasta verileri analiz edildi. Deklarasyon ve donasyon süreleri, donor sayısı ve organların kullanılabilirlik oranları incelenmiştir. Ayrıca, aile onayı olmasına rağmen tıbbi nedenlerle organları kullanılamayan olgular, bu sonucun altta yatan nedenleri açısından değerlendirildi. Bulgular: Çalışmaya 26 erişkin beyin ölümü olgusu dahil edilmiştir. Yedi (%26.9) hastada aile onayı mevcuttu. Aile onamı olan 7 olgunun 3’ünün organları transplante edilmiştir. Geri kalan olgulardan bir olgunun alınan ikinci RT-PCR testi pozitifti. Diğer olgularda her iki RT-PCR negatif olmasına rağmen laboratuar tetkikleri ve donasyon öncesi çekilen toraks tomografilerinde COVID-19 ekarte edilememişti, ayrıca kan kültürlerinde bakteriyemi mevcuttu. Donor olmayanların medyan lenfosit sayısı (0.665 × 109/L [0.340-0.770]), donorlere göre (1.182 ×109/L [1.050-1.780]) anlamı olarak düşüktü (p

Anahtar Kelimeler:

organ nakli, beyin ölümü, COVID-19

Brain Death and Organ Donation During the COVID-19 Pandemic: A Retrospective Observational Study

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1. Kumar D, Humar A. Pandemic influenza and its implications for transplantation. Am J Transplant. 2006;6(7):1512-7. doi:10.1111/j.1600-6143.2006.01364.x
2. Kaul DR, Mehta AK, Wolfe CR, et al. Ebola virus disease: implications for solid organ transplantation. Am J Transplant. 2015;15(1):5- 6. doi:10.1111/ajt.13093
3. World Health Organization. WHO Coronavirus (COVID-19) Dashboard. Available from: https://covid19.who.int/ (accessed date: 22 December 2021)
4. Organ and Tissue Transplantation Services Regulation, the Ministry of Health, Turkey. Available from: https://www.mevzuat.gov.tr/mevzuat?Mevzuat No=15860&MevzuatTur=7&MevzuatTertip=5 (accessed date: 01 February 2012)
5. Arsava EM, Demirkaya Ş, Dora B, et al. Turkish Neurological Society diagnostic guidelines for brain death. Turk J Neurol. 2014;20:101-4.
6. Republic of Turkey Ministry of Health. Coronavirus Screening for Potential Donors. Available from: https://organ.saglik.gov.tr/AllNews.aspx?q=4V/ Rsua850c21xrT4j071HUy38dyQWoNzy 1FpkcjwsZtuynTX65bvLnZPVXqGaYQ (accessed date: 20 January 2021)
7. Ahmed O, Brockmeier D, Lee K, et al. Organ donation during the COVID-19 pandemic. Am J Transplant. 2020;20(11):3081-8. doi:10.1111/ajt.16199
8. Angelico R, Trapani S, Manzia TM, et al. The COVID-19 outbreak in Italy: Initial implications for organ transplantation programs. Am J Transplant. 2020;20(7):1780-4. doi:10.1111/ajt.15904
9. Valdes E, Agarwal S, Carroll E, et al. Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2. J Neurol Sci. 2020;417:117087. doi:10.1016/j.jns.2020.117087
10. Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID- 19) Pandemic. CDC. Available from: https://www.cdc.gov/coronavirus/2019- ncov/hcp/infection-control- recommendations.html (accessed date: 10 September 2021)
11. Kentish-Barnes N, Siminoff LA, Walker W, et al. A narrative review of family members' experience of organ donation request after brain death in the critical care setting. Intensive Care Med. 2019;45(3):331-342. doi:10.1007/s00134-019-05575-4
12. Republic of Turkey Ministry of Health. Tissue, Organ Transplantation and Dialysis Services. Donations and Donors. Available from: https://organkds.saglik.gov.tr/dss/PUBLIC/Brai n_Death.aspx (accessed date: 10 January 2021)
13. Young GB, Lee D. Acritique of ancillary tests for brain death. NeurocritCare 2004;1(4):499-508. doi:10.1385/NCC:1:4:499
14. Migdady I, Rae-Grant A, Greer DM. Brain death evaluation during the pandemic. Neurology. 2020;95(15):693-694. doi:10.1212/WNL.0000000000010544
15. Wijdicks EFM, Varelas PN, Gronseth GS, et al. American Academy of Neurology. Evidence- based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010;74(23):1911-8. doi:10.1212/WNL.0b013e3181e242a8
16. Radaideh Y, Garg R, Abdalla AA, et al. Challenges in brain death determination and apnea testing for patients with COVID-19. J Stroke Cerebrovasc Dis 2020;29(12):105419. doi:10.1016/j.jstrokecerebrovasdis.2020.105419
17. Lumbreras C, Sanz F, González A, et al. Clinical significance of donor-unrecognized bacteremia in the outcome of solid-organ transplant recipients. Clin Infect Dis. 2001;33(5):722-6. doi:10.1086/322599
18. Paredes D, Gambra MP, Cervera C, et al. Characterization of the organ donor with bacteremia. Transplant Proc. 2007;39(7):2083-5. doi:10.1016/j.transproceed.2007.07.050
19. Rangeard O, Audibert G, Perrier JF, et al. Relationship between procalcitonin values and infection in brain-dead organ donors. Transplant Proc. 2007;39(10):2970-4. doi:10.1016/j. transproceed.2007.02.101
20. Fan BE, Chong VCL, Chan SSW, et al. Hematologic parameters in patients with COVID-19 infection [published correction appears in Am J Hematol. 2020 Nov;95(11)- :1442]. Am J Hematol. 2020;95(6):E131-E134. doi:10.1002/ajh.25774
21. Zhao Q, Meng M, Kumar R, et al. Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A systemic review and meta-analysis. Int J Infect Dis. 2020;96:131- 5. doi:10.1016/j.ijid.2020.04.086
22. Peng J, Qi D, Yuan G, et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID-19): A multicenter, cross- sectional study. J Clin Lab Anal. 2020;34(10)- :e23475. doi:10.1002/jcla.23475
23. Watts RP, Thom O, Fraser JF. Inflammatory signalling associated with brain dead organ donation: from brain injury to brain stem death and posttransplant ischaemia reperfusion injury. J Transplant. 2013;521369. doi:10.1155/2013/521369
24. Caliskan G, Sayan A, Kilic I, et al. Has the COVID-19 Pandemic Affected Brain Death Notifications and Organ Donation Time? [published online ahead of print, 2021 Aug 9]. Exp Clin Transplant. 2021;10.6002/ect.2021- .0090. doi:10.6002/ect.2021.0090