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Background <p>The low rate of organ donation in Germany has been&#xa0;linked to a deficit in the detection of patients with brain death (BD) in hospitals. It is unclear how crisis-related health system disruptions, such as the COVID-19 pandemic, affect this detection deficit.</p> Methods <p>Secondary data analysis of anonymized data from deceased patients with acute brain injury from Saxony, Saxony-Anhalt and Thuringia during the pre-pandemic and pandemic period (01/2019–12/2022). Pandemic phases were stratified according to the predominant SARS-CoV-2 variant. Logistic multilevel models were employed to assess outcomes including diagnosis of BD, deceased organ donations, missed cases with potential BD and organ donation-related interactions with the German Organ procurement organization. Models accounted for regional COVID-19 incidence and first-dose vaccination rates, as well as age, gender and types of brain injuries.</p> Results <p>A total of 11,100 deceased individuals from 136 hospitals were analyzed. An inverse association was observed between COVID-19 incidence and the determination of BD (adjusted odds ratio [aOR] 0.94, 95%CI [0.91; 0.97]; <i>p</i> &lt; 0.001) as well as deceased organ donation (aOR 0.94, 95%CI [0.90; 0.98]; <i>p</i> = 0.001). When stratified by pandemic phases, this inverse association was evident for both BD determination (aOR 0.92, 95%CI [0.87; 0.99]; <i>p</i> = 0.02) and deceased organ donation (aOR 0.90, 95%CI [0.83; 0.97]; <i>p</i> = 0.01) during the initial wild-type phase. In the alpha phase, the association was observed only for BD determination (aOR 0.76, 95%CI [0.59; 0.98]; <i>p</i> = 0.03). No association was found in subsequent pandemic phases.</p> Conclusion <p>The initial impact on BD detection during the pandemic highlights the importance of the health system's adaptive capacity in times of crisis.</p>

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Impact of the COVID-19 pandemic on brain death detection in German hospitals: a state-wide analysis of health data

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月24日

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  • Daniela Schoene,
  • Martin Roessler,
  • Katharina Eder,
  • Albrecht Günther,
  • Konrad Pleul,
  • Axel Rahmel,
  • Kristian Barlinn

摘要

Background

The low rate of organ donation in Germany has been linked to a deficit in the detection of patients with brain death (BD) in hospitals. It is unclear how crisis-related health system disruptions, such as the COVID-19 pandemic, affect this detection deficit.

Methods

Secondary data analysis of anonymized data from deceased patients with acute brain injury from Saxony, Saxony-Anhalt and Thuringia during the pre-pandemic and pandemic period (01/2019–12/2022). Pandemic phases were stratified according to the predominant SARS-CoV-2 variant. Logistic multilevel models were employed to assess outcomes including diagnosis of BD, deceased organ donations, missed cases with potential BD and organ donation-related interactions with the German Organ procurement organization. Models accounted for regional COVID-19 incidence and first-dose vaccination rates, as well as age, gender and types of brain injuries.

Results

A total of 11,100 deceased individuals from 136 hospitals were analyzed. An inverse association was observed between COVID-19 incidence and the determination of BD (adjusted odds ratio [aOR] 0.94, 95%CI [0.91; 0.97]; p < 0.001) as well as deceased organ donation (aOR 0.94, 95%CI [0.90; 0.98]; p = 0.001). When stratified by pandemic phases, this inverse association was evident for both BD determination (aOR 0.92, 95%CI [0.87; 0.99]; p = 0.02) and deceased organ donation (aOR 0.90, 95%CI [0.83; 0.97]; p = 0.01) during the initial wild-type phase. In the alpha phase, the association was observed only for BD determination (aOR 0.76, 95%CI [0.59; 0.98]; p = 0.03). No association was found in subsequent pandemic phases.

Conclusion

The initial impact on BD detection during the pandemic highlights the importance of the health system's adaptive capacity in times of crisis.