The brain dead patient is the ideal multiorgan donor. Conditions that
can lead to the state of brain death are limited. A subarachnoid
haemorrhage, intracerebral haemorrhage or traumatic brain injury precede
in 83% of the cases the state of brain death. Because of better
prevention and treatment options of these conditions, we anticipate a
further decline of brain death. Consequently, we have to evaluate other
possibilities to obtain organs. The research questions of this thesis
were how to improve organ donor recognition, how to increase family
consent for organ donation, and if presumed consent is a realistic
solution to solve the shortage of organs. To improve organ donor
recognition we proposed a new definition of a potential organ donor
based on a state we called ‘imminent brain death’. The definition of
‘imminent brain death’ was based on the Glasgow Coma Score and a new
neurological assessment score, the FOUR score. We compared this new
definition with results of the Organ and Procurement Transplantation
Network (OPTN). We furthermore investigated the ethical basis to obtain
consent for organ donation from consciousness patients of whom we
withdraw futile therapy. Additionally we studied changes in the timing
to initiate the discussion about organ donation with the relatives of a
patient. The final study concerns the external validation of a
prognostic model to predict the probability of death, of patients with a
devastating neurological condition, within 60 minutes after the
withdrawal of life sustaining measures.http://repub.eur.nl/res/pub/31413/120215_Groot%2C%20Yorick%20Jasper%20de.pdf
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