Impacto da implementação da resolução 2173 / 2017 do CFM no processo diagnóstico de morte encefálica doação de órgãos em um hospital público de Goiás em 2017 e 2018
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2022-12-16
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Universidade Federal de Goiás
Resumo
Brain death (BD) diagnosis is essential to establish potential donor status for organ
transplantation. In Brazil, the Federal Council of Medicine (CFM) establishes the
diagnostic parameters for BD. CFM Resolution 1480 / 1997 showed the need to
perform two clinical examinations (including two apnea tests) with a minimum interval
of six hours for patients aged two years or more. In 2017, Resolution 2173 / 2017
revoked the previous one and reduced the minimum interval to one hour between the
two examinations (requiring only one apnea test). In Brazil, organ donation after the
diagnosis of BD only occurs after an interview with family members of the potential
donor. This research aimed to evaluate the change resolution impact in the process
of diagnosis of BD-organ donation in the years 2017 and 2018 in a public hospital in
Goiás. Methodology: A descriptive-comparative study was conducted by collecting
data (retrospective) from the State Transplant Center of Goiás. The sample consisted
of patients diagnosed with brain death at HUGOL from 2017 to 2018 (n=230), 93
patients in 2017 and 137 in 2018. The following were evaluated: age, sex, cause of
coma, date and time of the first clinical examination, date and time of the second
clinical examination, the time between the two clinical examinations, date and time of
the complementary examination, time of diagnostic conclusion, date and time of
death, eligibility (submission to family interview), acceptance or refusal of organ
donation, and reason for family refusal. Results: Data distribution was not normal
(application of Kolmogorov- Smirnov test), and Mann-Whitney and Chi-square tests
were applied (95% CI and p≤0.05). The total time spent for the diagnosis of brain
death was reduced (p=0.014); when the complementary exam was performed
between the two clinical exams, the total time spent was reduced (p<0.001). The
causes of coma were: TBI, TBI/polytrauma, CVA, HCVA, arterial malformation,
hydrocephalus, CNS infection, sepsis, and tumor. Family from 108 patients refused
organ donation for the following reasons: unawareness of the DP's wish, no living donor, family members wishing the body intact, undecided family members, family
members against the donation, fear of the delay in releasing the body, religious
convictions, and others. Conclusion: CFM Resolution 2173 / 2017 promoted a
reduction in the time to diagnosis of brain death without impacting the decision of
acceptance/refusal of organ donation. The time to diagnosis was not a reported cause
for donation refusal. Organ donation depends on the community's knowledge about
the transplant program, the DP's living wishes, and conditions related to their own
beliefs. For this, we suggest public policies to encourage family dialogue on the
subject - of organ donation and transplants.
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CARNEIRO, L. S. Impacto da implementação da resolução 2173 / 2017 do CFM no processo diagnóstico de morte encefálica doação de órgãos em um hospital público de Goiás em 2017 e 2018. 145 f. Dissertação (Dissertação em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2022.