COVID-19 Tanılı Hastada Beyin Ölümü ve Donasyon
Özet
Bu makale, merkezi sinir sisteminin kafatası içindeki tüm aktivitelerinin geri dönüşümsüz kaybı olarak tanımlanan beyin ölümü kavramını, tanı kriterlerini ve COVID-19 pandemisinin organ donasyonu süreçleri üzerindeki etkilerini incelemektedir. Tıbben ve hukuken somatik ölüme eşdeğer olan beyin ölümünün tanısı; derin koma, beyin sapı arefleksisi ve pozitif apne testi olmak üzere üç temel bulguya dayanmaktadır. Ancak COVID-19'lu hastalarda apne testi sırasındaki aerosol yayılımı riski, tanı sürecinde CPAP modunun kullanılması veya tam koruyucu ekipman giyilmesi gibi modifikasyonları zorunlu kılmıştır. Literatürde COVID-19 enfeksiyonuna sekonder gelişen tromboz ve ensefalopati kaynaklı beyin ölümü olguları bildirilmiş olsa da, enfekte donörlerden alıcılara virüs bulaşma riski ve post-transplant immünsüpresif tedavi gereksinimi gibi faktörler nedeniyle COVID-19 pozitif bireylerden organ donasyonu önerilmemektedir. Pandemi dönemi, yoğun bakım ekiplerinin artan iş yükü, karantina kısıtlamaları ve ailelerle yüz yüze iletişim kurulamaması gibi yapısal engeller sebebiyle hem beyin ölümü bildirimlerini azaltmış hem de donasyon süreçlerinin uzamasına yol açmıştır. Sonuç olarak, SARS-CoV-2 kaynaklı organ disfonksiyonları ve bulaş riskleri göz önünde bulundurularak, pandemi sürecinde bu vakalardan organ nakli yapılması tavsiye edilmemektedir.
This article examines the concept of brain death, defined as the irreversible loss of all intracranial central nervous system activities, along with its diagnostic criteria and the impacts of the COVID-19 pandemic on organ donation processes. Brain death, medically and legally equivalent to somatic death, relies on three core clinical findings for diagnosis: deep coma, brain stem areflexia, and a positive apnea test. However, the risk of aerosol dissemination during apnea testing in COVID-19 patients has necessitated modifications such as utilizing CPAP modes or wearing full protective equipment. Although cases of brain death resulting from COVID-19-induced thrombosis and encephalopathy have been reported in the literature, organ donation from COVID-19 positive individuals is not recommended due to the potential risk of transmission to recipients and post-transplant immunosuppressive treatment requirements. The pandemic period has both reduced brain death notifications and prolonged donation periods due to structural barriers, including the heavy workload of intensive care teams, quarantine constraints, and the inability to establish face-to-face communication with families. Consequently, considering SARS-CoV-2-related organ dysfunctions and transmission risks, transplantation from these donors is not advised during the pandemic.
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