Effect of Reducing Physician Requirements on Brain Death Confirmation and Organ Donation Outcomes in ICU: A Retrospective Cohort Study

Background Timely and accurate determination of brain death is critical for optimizing organ donation processes. Prolonged diagnostic intervals can compromise the viability of donor organs and reduce transplant opportunities. In 2014, Turkey amended its legislation to reduce the number of physicians required to confirm brain death from four to two. This study evaluates the impact of this legislative change on diagnostic timing and organ transplantation outcomes in a tertiary intensive care unit (ICU). Methods We conducted a retrospective cohort study analyzing cases of brain death diagnosed before and after the legal amendment. Data were collected from the ICUs at our institution. The primary outcome were the time interval from suspicion to confirmed diagnosis of brain death, and the secondary outcomes were reason for brain death diagnosis and, organ transplantation rates. Results The study included patients diagnosed before and after the 2014 legal revision with 322 patients. Median time to confirmed brain death decreased significantly from 3683 minutes [3020–4535] pre-legislation to 2678 minutes [2324–3638] post-legislation ( p  < 0.001). A significant reduction was also observed in the overall time from initial suspicion to cardiac arrest ( p  < 0.001). However, the organ donation rate did not significantly different between the two time periods ( p  = 0.296). Conclusion Reducing the number of physicians required for brain death confirmation was associated with a marked decrease in diagnostic time. While this did not significantly impact donation rates, it represents a crucial procedural improvement.