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Background and purpose The increased demand for donor organs has made it crucial to keep the organs of patients with impending brain death (PWIBDs) suitable for transplantation during the process of determining brain death. This study aimed to identify the time taken to determine brain death (TT-BD) in PWIBDs and the associated influencing factors. Methods This study analyzed data collected by the Korean Organ Donation Agency from 15 hospitals in the Yeongnam region of South Korea. There were 414 PWIBDs eligible for inclusion in this study. The data consisted of the TT-BD for PWIBDs and the potential variables influencing the TT-BD. Results The mean age of the 414 PWIBDs was 48.9 years, and 120 of them were female (29.0%). The mean TT-BD was 8.5 days. The presence of spontaneous movements (SMs) and craniotomy significantly affected the TT-BD. The mean TT-BDs were 13.9 and 8.2 days in the PWIBDs with and without SMs, respectively, and 9.8 and 8.0 days in the PWIBDs with and without craniotomy, respectively. Conclusions The SMs in PWIBDs and a craniotomy performed immediately before starting the process of determining brain death seem to be related to lengthening the TT-BD.

Background: The number of deceased donors that have increased annually until 2016 has started to decline in the last three years. This study therefore intends to analyze the trend of potential brain death reported to Korea Organ Donation Agency (KODA) and use the analysis results as a basic data for the activation of organ donation. Methods: A comparative analysis was performed for the first period (P1: 2014 to 2016) where the number of donations continued to increase and the second period (P2: 2017 to 2019) that showed decline in donations compared to 2016. Results: The cases of potential brain death reported to KODA was 5,548 in P1 and 7,126 in P2, a 28.4% increase from the previous period. Among these, the cases of medically suitable for organ donation increased by 36.5%, from 4,053 in P1 to 5,534 in P2. Decreased the consent rate from 52.9% in P1 to 37.2% in P2. The discontinuation of donation process even after family consent increased by 17.6% (from 74 cases in P1 to 87 cases in P2), mostly due to legal issues and death before the judgment of brain death. Conclusions: The decrease in families’ consent for organ donation turned out to be the biggest cause of declining donation. The major reasons for refusal to donation such as can be attributed to the lack of understanding of the medical state of brain death, a negative image of sharing and donation that is pervasive in Korean society, and the distrust between community members. Therefore, there is a need for education and promotion at a national level to enhance the awareness of the value of life and to en courage the public to practice the value of sharing.

Background: According to the statistics of the National Agency for Management of Life-Sustaining Treatment, 85,000 end of life care patients have been withdrawn life sustaining treatment over two years since the implementation of law in February 2018. However, according to annual report of Korea Organ Donation Agency (KODA), there were a considerable number of patients who requested to withdraw life sustaining treatment among the referred potential brain death to the call center of KODA. Their family consent rate was lower than the group that didn’t mentioned about interrupting the end of life care. Methods: The study was designed using the referred cases of potential brain death to KODA during 2018 and 2019. Demographic findings of requesting withdrawn life sustaining treatment among the referred cases and their result of donation progress in each step were evaluated. Results: Within the research period, there were a total of 4,910 cases (2,426 in 2018, 2,484 in 2019) of brain death, and among them, 569 (193 in 2018 and 376 in 2019) cases requested to withdraw life sustaining treatment. This means a 94.8% increase in requesting family compared to the previous year. In terms of gender, 63% of the cases were male, and the most common age group was the fifties (23.4%). Among 569 requested donors, 475 (83.5%) were appropriate for organ donation, out of which, 394 (82.9%) families were interviewed about organ donation, and accepted organ donation in 45 cases (9.5%). Only 29 cases (6.1%) were succeeded in organ procurement. Conclusions: It is estimated that there will be more families who wish to withdraw life sustaining treatment among potential brain death referred to KODA for organ donation in the future. Therefore, in order to activate organ donations, we need a system revision about end of life care process, first to the donor coordinator and then explain all the options by that coordinator.