Background: In cases of brain death resulting from external causes, such as accidental death, rather than natural death from a disease, an investigation is necessary to determine whether the cause of death was a crime. Autopsy is one of the main causes of cessation of organ donation during such investigations. Cessation of organ donation due to autopsy results in loss of time, cost, and manpower for the donor's family and many medical professionals, and it also deprives transplant candidates of transplantation opportunities. Through the analysis of cases where autopsy was considered after consent for brain death organ donation, we seek to find alternative methods to reduce donation cessation.
Method: A retrospective analysis was conducted on 22 out of 752 brain-dead individuals due to external causes who underwent autopsy from January 1, 2020 to April 1, 2023 based on data from the Korea Organ & Tissue Donation Organization.
Results: Of the 1,573 subjects who underwent brain death determination from January 1, 2020 to April 1, 2023, 752 (47.8%) were due to external causes, and among them, 11 underwent brain death organ donation after organ extraction. The types of accidents were diverse, including assault (2), fire (1), poisoning (1), hanging (2), falling (2), industrial accidents (1), and others or unknown (2). However, among the 11 cases in which organ donation was discontinued due to autopsy during the brain death determination process, assault was the most common cause (7), followed by falling (1), industrial accidents (1), and medical accidents (2). The timing of cessation was after completion of the first brain death investigation in one case, after completion of the EEG examination in one case, and after completion of the brain death determination committee in nine cases. Among the 11 brain-dead individuals who had organ donation cessation, 39 transplant candidates who waited for organs from them did not receive organs: 3 hearts, 4 lungs, 9 livers, 20 kidneys, and 3 corneas.
Conclusion: Based on the results of this study, in cases of brain-dead individuals due to external causes, especially those due to assault, it is necessary to confirm whether autopsy and extraction will be performed before starting brain death determination. Legal, medical, and social alternatives should be sought through the cooperation of organ procurement agencies, medical institutions, and investigative agencies to minimize cases where extraction is discontinued due to autopsy after brain death organ donation. Autopsy of brain-dead donors due to external causes will continue to occur in the future, and there is an urgent need for solutions to this problem.