ArticleBMC anesthesiology2026
Association of reduced physician requirements with brain death confirmation pathway duration and organ donation outcomes in the ICU: a retrospective cohort study.
Article in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTimely and accurate determination of brain death is important for donor evaluation and coordination. Prolonged diagnostic intervals may affect operational efficiency in donor evaluation and coordination, although their physiologic consequences are not uniform. In 2014, Turkey amended its legislation to reduce the number of physicians required to confirm brain death from four to two. This study evaluates the impact of this legislative change on diagnostic timing and organ donation-related outcomes in a tertiary intensive care unit (ICU).
methodsWe conducted a single-center retrospective cohort study including adult ICU patients with legally confirmed brain death between 2007 and 2019. Patients were categorized into pre-amendment (before 2014) and post-amendment (2014 onward) cohorts according to the period of diagnosis. The primary outcome was the time from first documented ICU suspicion of brain death to legal confirmation. Secondary outcomes included the time from first documented suspicion to cardiac arrest in non-donor patients, organ donation status, and reasons for non-donation.
resultsA total of 322 patients with legally confirmed brain death were included (166 patients in the post-amendment period and 156 patients in the pre-amendment period). The median time from first documented ICU suspicion of brain death to legal confirmation was significantly shorter after the legislative amendment (44.6 [IQR 38.7–60.6] vs. 61.4 [IQR 50.3–75.6] hours; p < 0.001). In adjusted quantile regression analysis controlling for age, sex, etiology of brain death, and calendar year, the pre-amendment period remained independently associated with a longer confirmation pathway (adjusted median difference 14.6 h, 95% CI 9.9–19.3).
conclusionReduction in the number of physicians required for legal confirmation of brain death was associated with a substantial shortening of the clinical-administrative pathway from first documented ICU suspicion to confirmation. However, this process improvement did not translate into higher organ donation rates. Persistent family refusal suggests that procedural streamlining alone is insufficient to improve donation outcomes.
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