J. A. Marks1, J. Hatchimonji1, P. Kim1, D. N. Holena1, J. Pascual1, P. M. Reilly1, N. D. Martin1 1University Of Pennsylvania,Division Of Traumatology, Surgical Critical Care And Emergency Surgery,Philadelphia, PA, USA
Introduction:
Organ availability remains a major limitation to organ transplantation. Patients with devastating head injuries are a frequent source of transplantable organs, but when concomitant injuries exist, potential reluctance for aggressive care may develop for fear of not realizing organ donation. We aim to evaluate this cohort, and determine the efficacy of major, non-neurologic operations prior to organ donation.
Methods:
All severe head injured adult trauma patients (AIS Head ≥5) from January 2004 to December 2013 were reviewed retrospectively. Demographics, mortality, and organ donation was recorded. Major non-neurologic operations performed prior to organ donation were also abstracted. Quantitative and qualitative assessments of this cohort were determined.
Results:
During the study period 1194 patients with AIS Head ≥5 were identified. Of those, 465 patients died; 79 of whom successfully donated organs. 40 of the 79 donors had significant injuries as determined by an AIS>2 in an alternate body region. Of these, eight patients underwent a total of 11 major operative interventions. These included non-resuscitative thoracotomy, laparotomy with gastorrhaphy, entrectomy, colectomy, splenectomy, liver packing, hepatorrhaphy and cystorrhaphy. Of note, although nine resuscitative thoracotomies were performed among the 465 deaths, none of these realized organ donation despite seven patients surviving to ICU admission.
Conclusion:
In patients with devastating head injuries, major concomitant injury requiring operation does not preclude organ donation. Aggressive non-neurologic operative care can preserve the option for donation in select cases.