Due to advances in medical science, fewer people suffering from brain injuries go on to die from those injuries and get declared as “brain dead,” according to a recent Canadian study. The resulting survivals may explain why organ donation as a whole hasn’t increased, despite more people becoming donors over the years.
Published in the Canadian Medical Association Journal, the study upholds many organ donation programs’ claims that one person has the potential to save as many as eight lives through donation. Researchers involved with the study point out that donation after neurologic death (i.e. brain death) accounts for half of kidney transplants, three-quarters of liver transplants, 90 percent of lung and pancreas transplants, and all heart and small bowel transplants. In other words, for these donations to occur, people must first surrender their brains. If that doesn’t happen, neither do the donations.
Researchers looked at 2,788 patients from Calgary, Alberta, and found the odds of brain death following injury decreased over the course of the 10-year study.
"Our finding that a reduced proportion of patients with brain injury progressed to neurologic death suggests that initiatives aimed at improving road safety, preventing injuries during recreational activities, and improving prehospital and in-hospital care, have had an effect and should continue to be promoted," wrote Dr. Andreas Kramer, a physician at the University of Calgary, with co-authors.
Between 2006 and 2010, traffic-related deaths decreased by 24 percent. Nonfatal collisions also decreased, despite consistent population growth.
In the United States, the suggested problem has ballooned over the decades. Between 1988 and 2006, the number of transplants doubled, while the number of people needing a transplant increased six-fold. Coupled with the fact that not everyone who dies is an organ donor, some organs demand a person be dead before they can be harvested or transplanted — such is the case with livers, hearts, and lungs.
This scenario, where organ donation can only increase when more people die, makes for a puzzling, pressure-filled challenge for scientists. Brain death means the patient still has a pulse: this makes the organs still viable. There are seemingly only two options in such cases. Either doctors keep fewer people alive after brain injuries, or they find ways to bypass the brain’s death altogether in order to supply someone with an organ. The first solution is ethically impossible, which means, to satisfy both imperatives — keeping brain injury victims alive and providing healthy organs to people who need them — more creative methods must be designed.
"If organ transplantation rates are to increase,” the team argued, “it will need to occur through alternative approaches, such as living donation, donation after cardiocirculatory death and innovations aimed at improving the use of donated organs.”
In the U.S., approximately 18 people die each day because they could not receive an organ donation. The current waiting list is 120,451-people-long.
Source: Kramer A, Zygun D, Doig C. Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region. CAMJ. 2013.