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Predictive models, a new tool for managing organ procurement process

Predictive models allow us to improve the understanding of the complex process that ends in brain death (BD). This increased knowledge about the process opens a wide range of possibilities: allow us to organize and plan health policies and programs, optimize clinical management, communicate and inform relatives more precisely, and eventually manage the process of organ procurement. Moreover, based on these models and taking in account data about local epidemiology and treated population, the potentiality of organ procurement in a given country, region, or hospital can be estimated. Knowing the estimated potential, we can document the efficiency of the organ procurement process to subsequently take action to improve it. Predictive models are therefore essential tools from the clinical point of view and have a privileged place in planning mediumand long-term transplant programs. The mortality of patients with severe brain injury is high, a large portion of these deaths occur in BD. Which are the main factors affecting this process? In other words, which are risk factors for death and if this happens which factors determine a higher risk of BD or cardiac arrest (CA). Naturally to make progress in this area of knowledge, we must thoroughly study each particular pathology because each one presents different epidemiological and evolutionary behavior with a highly variable attributable mortality. On the one hand, the incidence of each disease is different in different age and gender groups. Also some diseases, such as ischemic stroke, for example, are markers of the probable presence of atherosclerotic vascular disease whose presence reasonably modifies the risk of cardiovascular cause of death. Moreover, the increasing age increases the prevalence of chronic diseases such as hypertension and also cardiovascular reserve decreases. On the other hand, age increases the intracranial spatial buffer thus acting as a protective factor of evolution to BD in the case of the accumulation of new intracranial volumes. These aspects are just an example of the complex network of interactions that do most of the time difficult to predict the final outcome of a particular patient.