Fewer patients with brain injury progressing to ‘brain death’

Fewer patients suffering from brain injuries are being declared “brain dead,” according to a new study published in the Canadian Medical Association Journal.

While the findings represent good news for many, the researchers noted that they also hold some negative implications for other areas of health care.  On the one hand, the trend may be reflective of better injury prevention techniques and improved care for patients with head injuries.  But conversely, this decrease in brain dead patients also correlates with decreased rates of an extremely vital medical need: organ donation.

“In Canada and in the U.S., the most common scenario where a dying patient can become an organ donor is if they have progressed to this state called brain death, which is the irreversible cessation of all brain function; it usually means there’s no blood flow to the brain either,” lead author Dr. Andreas Kramer, a physician with the departments of critical care medicine and clinical neurosciences at the University of Calgary, Alberta, told FoxNews.com.  “That patient is very appropriate to become an organ donor.”

Prior to the start of their study, Kramer and his colleagues had observed that rates of organ donations in Canada were lower than they had been a decade ago – despite national and local efforts to promote organ donation.

To better understand the reasons behind the decreased rates, the researchers analyzed 2,788 patients who had been admitted to four hospitals in Calgary Alberta over a 10-year period.  All of the patients in the study had suffered from one of the leading causes of brain death: brain injury from trauma, brain injury from different types of strokes or brain injury from cardiac arrest.

The researchers found that during the time period studied, the percentage of patients with brain injury who progressed to neurologic death decreased from 8.1 percent in 2002 and 9.6 percent in 2004 to 2.2 percent in 2010.

According to Kramer, these statistics may be explained by a number of improvements made to health care practices over the past decade.

“When patients are injured and have a head injury, there’s a whole number of steps in caring for those patients: getting the ambulance on scene, getting patients transferred and getting things they need to have done at a trauma center,” Kramer said.  “Today, there’s faster transportation, trauma teams are better organized, and neurosurgeons tend to be more aggressive in caring for those patients…I think it would be simplistic to attribute (the numbers) to just one thing.”

While lower rates of brain death can be considered good news, Kramer said this trend most likely explains the decrease in organ donation rates the researchers observed before the start of the study.  Donations after brain death account for approximately half of kidney transplants, 75 percent of liver transplants and nearly 90 percent of lung and pancreas transplants.  Furthermore, 100 percent of heart and small bowel transplants come from patients with neurologic death.

Given the strong relationship between organ donation rates and neurologic death, Kramer said his study’s findings should serve as reminder that a decrease in organ donation rates does not necessarily indicate a failure of the current health care system.

“I think it’s important that we not kid ourselves into thinking that the number of organ donors we have is necessarily a reflection of the quality of our system,” Kramer said.  “In Canada, we have lower organ donation rations, so people frequently look at that and say we should be doing something differently.  The fact is if a society does a poor job of caring for brain injury, then they’ll have more organ donations.  A tragedy has to happen first before a patient becomes an organ donor.”