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PubMed · 3404164

Primary brainstem death: a clinico-pathological study.

J Ogata·M Imakita·C Yutani·S Miyamoto·H Kikuchi
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Abstract

A case of primary brainstem death in a man with surgically treated cerebellar haemorrhage is reported. Necropsy revealed extensive necrosis confined to the brainstem and cerebellum. The absence of diabetes insipidus and the persistence of electroencephalographic activity were the characteristic clinical features of the case. This differentiates the condition from so-called "whole brain death". Analysis of three further cases with acute vascular lesions of the brainstem or cerebellum, shown at necropsy, revealed that primary brainstem death with prolonged somatic survival can occur in specific circumstances after surgical intervension.

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Brain DeathBrain StemCerebellumCerebral CortexCerebral HemorrhageCerebral VentriclesComaHumansMaleMiddle AgedNecrosisCase ReportsJournal ArticleResearch Support, Non-U.S. Gov't

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J Ogata, M Imakita, C Yutani, S Miyamoto, H Kikuchi. 1988. Primary brainstem death: a clinico-pathological study.. https://doi.org/10.1136/jnnp.51.5.646

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Transplantation of kidneys from donors whose hearts have stopped beating.

BACKGROUND: Attempts have recently been made to expand the number of cadaveric kidneys available for transplantation by using kidneys from donors without heartbeats in addition to those from brain-dead donors with beating hearts. We studied the efficacy of transplanting kidneys from donors without heartbeats on the basis of aggregate results from the Kidney Transplant Registry of the United Network for Organ Sharing. METHODS: We compared the early function and survival rates of 229 kidney grafts from donors without heartbeats with those of 8718 grafts from cadaveric donors with heartbeats. All transplantations were performed at 64 U.S. transplantation centers. Cox proportional-hazards analysis was used to evaluate 10 major risk factors for graft failure. RESULTS: The survival rate at one year was 83 percent for kidney grafts from donors without heartbeats, as compared with 86 percent for grafts from donors with heartbeats (P=0.26). Among the kidneys from donors without heartbeats, the survival rate at one year was 89 percent for grafts from donors who had died of trauma, as compared with 78 percent for grafts from donors who had died of other causes (P=0.04). The survival rates were high for grafts from donors without heartbeats despite the poorer early function of these grafts; 48 percent of the recipients required dialysis within the first week after transplantation, as compared with 22 percent of the recipients of grafts from donors with heartbeats. The primary-failure rate for kidneys from donors without heartbeats was 4 percent, as compared with 1 percent for kidneys from donors with heartbeats. CONCLUSIONS: Transplantation of kidneys from donors whose hearts have stopped beating, especially those who have died of trauma, is often successful, and the use of kidneys from such donors could increase the overall supply of cadaveric kidney transplants.

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