Changing Trends in Brain Death at an Inner-City Hospital: A 12-Year Experience

Introduction: Over the past decade, patient characteristics and donation patterns in organ donation occurring after neurological determination of brain death have evolved due to clinical, demographic, and societal changes.This study aimed to evaluate trends in donor characteristics, brain death etiology, and donation specifics over a decade in an inner-city hospital.Methods: This is a retrospective observational analysis of adult patients diagnosed with brain death between January 2013 and June 2025, divided into two periods (Periods I and II).Results: Lung disease was more frequent in Period II (41.4% vs. 26.0%;p = 0.025).Overall urine toxicology positivity increased significantly (49% vs. 25.3%;p = 0.003), with a specific increase in cocaine detection (26.9% vs. 10.8%;p = 0.010).The organ donor rate increased from 4.55 to 8.07 donors per year (p = 0.018), while the proportion of brain-dead patients who became organ donors did not differ significantly between periods (34% vs. 32%).Conclusions: This analysis demonstrated an increased annual rate of organ donation after brain death in the post-2020 period, while the proportion of brain-dead patients who became organ donors did not differ significantly between periods.A higher prevalence of positive toxicology screens, particularly for cocaine and cannabinoids, was also observed.Over the past decade, there appears to have been a shift in demographic characteristics and patterns of drug use.