TRANSCRANIAL DOPPLER FOR EARLY IDENTIFICATION OF POTENTIAL ORGAN TRANSPLANT DONORS

Background: Encouraging results in transplant medicine create a growin g demand for organ transplant donors. Transcranial Doppler (TCD) has b een used by several investigators to assess arrest of the cerebral cir culation in brain dead patients. We report on TCD as a monitoring tool for early identification of potential organ transplant donors. Design : A prospective clinical study. Setting: Intensive care unit (ICU) of a 900-bed community hospital (primary and tertiary care center) in Vie nna, Austria. Subjects and methods: All patients with acute intracrani al lesions admitted to our intensive care unit underwent TCD examinati on at least once daily, In patients with Glasgow Coma Scores <7, TCD w aveforms with high resistance profiles unchanged by therapeutic attemp ts to lower intracranial pressure indicated the need for repeated TCD up to four times a day. TCD waveform abnormality consisting of absent or reversed diastolic flow or small early systolic spikes in at least two intracranial arteries was considered to constitute intracranial ci rculatory arrest. Brain death was confirmed by clinical criteria, an i soelectric electroencephalography (EEG) or non filling of the intracer ebral arteries on arteriography. Results: From January 1994 to July 19 96 we identified 11 comatose patients as potential organ transplant do nors with typical TCD findings indicating intracranial circulatory arr est. Diagnosis was subarachnoid hemorrhage in 7 and intracerebral hemo rrhage in 4 patients. Brain death diagnosis according to the criteria of Austrian law was initiated immediately after the TCD findings sugge sted intracranial circulatory arrest. Confirmation of brain death was obtained by clinical criteria and either EEG (6 patients) or cerebral angiography (5 patients). Conclusion: TCD examinations on a daily rout ine basis offer a noninvasive monitoring method for early assessment o f intracranial circulatory arrest. TCD enables quick identification an d further diagnosis of candidates for organ transplant donation.