A survey on patients admitted in severe coma: implications for brain death identification and organ donation



To identify factors to improve the identification of brain dead patients in intensive care units (ICUs).

Design and setting

Prospective study conducted in 79 ICUs in 54 hospitals.


All hospitalized patients with a Glasgow Coma Scale (GCS) score less than 8.

Measurements and results

During the study period hospital staff completed a form for each patient with a GCS less than 8. Hospital information units provided us with statistics from the discharge forms. The characteristics of the hospitals were also recorded. We included a total of 792 patients with a GCS less than 8; 120 of these patients were diagnosed as being clinically brain dead (15.1%). These patients accounted for 11.8% of the comatose patients in ICUs, 11.7% of the deaths occurring in ICUs, and 3.3% of the deaths that occurred in the hospital during the study period. Two multivariate linear regressions were performed to predict the number of clinically brain dead patients in the ICUs. The regression analyses included causes of death or causes of coma, and hospital characteristics. The presence of a coordination team and the number of transplant coordinators were positively associated with the number of brain dead patients in both models. The number of patients carried to the ICU by a mobile emergency unit was also positively associated in the model with causes of coma.


Increasing the number of hospital coordinators and collaboration with mobile emergency units should lead to the identification of more brain dead patients among comatose patients in ICUs.

This is a preview of subscription content, log in to check access.

Fig. 1.


  1. 1.

    Etablissement français des Greffes (2001) Rapport d'activité et bilan des activités de prélèvement et de greffe en France en 2000. EfG, Paris

  2. 2.

    Organizacion Nacional de Trasplantes (2001) Memoria de la actividad de donacion y trasplante 2000. ONT, Madrid

  3. 3.

    United Network for Organ Sharing (2000) Annual report of the U.S. scientific registry for transplant recipients and the organ and transplantation network. UNOS, Richmond

  4. 4.

    Salih MA, Harvey I, Frankel S, Coupe DJ, Webb M, Cripps HA (1991) Potential availability of cadaver organs for transplantation. BMJ 302:1053–1055

    CAS  Article  Google Scholar 

  5. 5.

    Navarro A (1996) Brain death epidemiology: the Madrid study. Transplant Proc 128:103–104

    Google Scholar 

  6. 6.

    Espinel E (1989) The capacity for organ generation of hospital in Catalonia, Spain: a multicentre study. Transplant Proc 21:1419–1421

    CAS  PubMed  Google Scholar 

  7. 7.

    Siminoff LA, Arnold RM, Caplan AL, Virnig BA, Seltzer DL (1995) Public policy governing organ and tissue procurement in the United States. Ann Intern Med 12:10–17

    Article  Google Scholar 

  8. 8.

    Waller JA, Haisch CE, Skelly JM, Goldberg CG (1993) Potential availability of transplantable organs and tissues in fatalities from injury and nontraumatic intracranial hemorrhage. Transplantation 55:542–546

    CAS  Article  Google Scholar 

  9. 9.

    Garrison RN (1991) There is an answer to shortage of organ donors. Surg Obstet Gynecol 173:391–396

    CAS  Google Scholar 

  10. 10.

    Nathan HM, Jarrell BE, Broznik B, Kochik R, Hamilton B, Stuart S, Ackroyd T, Nell M (1991) Estimation and characterization of the potential renal organ pool in Pennsylvania. Transplantation 61:142–149

    Article  Google Scholar 

  11. 11.

    Gore SM, Cable DJ, Holland AJ (1992) Organ donation from intensive care units in England and Wales: two year confidential audit of death in intensive care. BMJ 304:349–355

    CAS  Article  Google Scholar 

  12. 12.

    Cuende N, Canon JF, Alonso M, Delagebasala CM, Sagredo E, Miranda B (2001) Programa de garantia de calidad en el proceso de donacion y trasplante de la Organizacion Nacional de Trasplantes. Nefrologia 21 [Suppl 4]:65–76

  13. 13.

    Jouan M, Claquin J (1996) Inquiry "INSERM 1992": opposition to organ harvesting. Transplant Proc 28:390–391

    CAS  PubMed  Google Scholar 

  14. 14.

    Benoit G, Aoun E, Auzepy P (1990) Pour faciliter le don d'organes en Ile-de-France. Presse Med 19:162–165

    Google Scholar 

  15. 15.

    Gortmaker SL, Beasley CL, Brigham LE, Franz HG, Garrison RN, Lucas BA, Patterson RH, Sobol AM, Grenvik NA, Evanisko MJ (1996) Organ donor potential and performance: size and nature of the organ donor shortfall. Crit Care Med 24:432–439

    CAS  Article  Google Scholar 

  16. 16.

    Roels L, Wight C (2001) Donor Action: an international initiative to alleviate organ shortage. Prog Transplant 11:90–97

    CAS  Article  Google Scholar 

  17. 17.

    Matesanz R, Miranda B, Fernandez Lucas M, Naya MT, Felipe C (1996) Contribution of nontransplant and small hospitals to organ procurement in Spain. Transplant Proc 28:232–233

    CAS  PubMed  Google Scholar 

  18. 18.

    Gubernatis G, Vogelsang F, Kolditz M, Bladtke L, Plessen V, Schafer H, Basse H, Smit H, Zickgraf T, Pichlmayr R, Ketzler K (1997) Professionalization of service for organ donation at peripheral hospitals including total quality management has nearly doubled organ donation in two years. Transplant Proc 29:1489–1492

    CAS  Article  Google Scholar 

Download references


The authors gratefully acknowledge the participation of the ICUs and medical information units, especially Dr. Louis Brunel (Direction de l'informatique médicale, Assistance Publique des Hôpitaux de Paris) who constructed a special computer program to collect data from the discharge forms for all patients hospitalized in the participating ICUs.

Author information



Corresponding author

Correspondence to Philippe Tuppin.

Additional information

An editorial regarding this article can be found in the same issue http://dx.doi.org/10.1007/s00134-003-1998-2

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Senouci, K., Guerrini, P., Diene, E. et al. A survey on patients admitted in severe coma: implications for brain death identification and organ donation. Intensive Care Med 30, 38–44 (2004). https://doi.org/10.1007/s00134-003-1923-8

Download citation


  • Organ donors
  • Organ procurement
  • Brain death
  • Medical records
  • Critical illness