To determine if the [institution] Catastrophic Brain Injury (CBI) protocol improved organ viability from donation after brain death (DBD) patients.

Most organ donations in the US are provided by brain dead patients. It is essential these patients are optimally managed in the intensive care unit (ICU) to ensure their organs remain viable for donation in the event of DBD. A growing area of research stems from the need to clearly define how these patients should be managed to optimize organ viability. The CBI protocol, implemented in 2014, aimed to standardize the management of hemodynamic instability from central diabetes insipidus in catastrophic brain injury patients, many of whom progress to brain death. In this retrospective study, we evaluate the effect of the CBI protocol on organ procurement in DBD patients.

We reviewed the electronic medical records of all patients declared brain dead from a single center neuroscience ICU from 2011 – 2023. We collected data including vasopressor use, urine output, and electrolyte derangements. In collaboration with the organ donation agency which receives the donated organs, data was collected concerning types of organs (heart, kidney, liver, lung, pancreas) and numbers of organs procured. Data was compared pre- and post- CBI protocol initiation using chi-squared test and unpaired t-test.

There was a 14% increase in use of vasopressin alone (p=0.02) post-protocol compared to pre-protocol. There were no differences in urine output (p=0.06), serum sodium (p=0.08), or total number of organs donated per patient (p=0.17).

The clinical management of impending DBD patients is challenging. The implementation of the CBI protocol standardized management of DI and provided more hemodynamic stability in brain death declaration. Future studies are needed to evaluate the impact of the CBI protocol on long term organ viability.