ArticleJournal of intensive care2026
Sequence and timing of organ donation discussions in brain-dead donors: a subanalysis of the J-RESPECT study.
Article in Journal of intensive care, 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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25 authors.
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Abstract
backgroundThe optimal timing of organ donation discussions in patients with catastrophic brain injury remains unclear. In Japan, national guidance recommends providing information after recognition of a state compatible with brain death; however, real-world practice has not been well characterized. This study aimed to evaluate the sequence of organ donation option presentation relative to clinical determination of a brain death-compatible state and to assess option presentation timing.
methodsWe conducted a multicenter retrospective cohort study using data from the J-RESPECT study, including adult brain-dead donors from 16 institutions in Japan between 2010 and 2023. Donors were classified as brain death-first (option presented after clinical determination of a brain death-compatible state) or option-first (option presented before such determination). Mixed-effects logistic and linear regression models with random intercepts for institution were used to examine factors associated with presentation sequence and timing.
resultsAmong 190 donors, 76 (40%) were classified as brain death-first and 114 (60%) as option-first. In mixed-effects logistic regression, age was the only independent factor associated with presentation sequence (adjusted OR 1.03 per year, 95% CI 1.00-1.07), while substantial between-institution variability was observed (intraclass correlation coefficient = 0.32). Institutional timing policy was not significantly associated with presentation sequence. The median interval from admission to option presentation was 5 days in the brain death-first group and 2 days in the option-first group (p < 0.001).
conclusionsSubstantial inter-institutional variability exists in the sequence and timing of organ donation discussions in Japan. Further studies are needed to determine optimal approaches to organ donation communication and timing in clinical practice.
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