Grant: Project Grant

Organ donation can only commence once death has been declared in a potential donor, however, the prediction of how quickly death will occur following removal of life support interventions is very unclear. Further, the longer the duration between the removal of life support and death declaration, the more the potential organs that are eligible to be transplanted become injured from low blood flow and oxygen levels during the dying process. The prediction of the dying duration, trajectory and whether or not organ donation will be successful is extremely limited. Robust, generalizable and reproducible methods for this prediction are needed to inform donation and transplant teams as well as patients and their families. The brain controls various vital functions of the human body. Relative to organ donation, severe brain dysfunction can accelerate the dying duration by leading to upper airway compromise (from bulbar motor dysfunction) or by leading to cardiac cessation from severe autonomic nervous system dysfunction. Quantifying and assessing these metrics in prospective organ donors is an essential step to develop a clinical prediction tool. We will conduct a multicenter prospective observational study to create a new and novel prediction tool that evaluates the severity of brain dysfunction in prospective organ donors. Specifically, we will evaluate blood-based brain biomarkers, neuroimaging features of increased intracranial pressure and heart rate variability (as marker of autonomic nervous system dysfunction) in eligible organ donors in the intensive care unit from to cessation of life support. Combining these assessments, we will create a new and novel multivariable prediction tool of the dying duration and will assess it against the currently available modest prediction variables and "physician gestalt".