{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:55:31Z","timestamp":1791453331988,"version":"4.3.3"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>The effectiveness of goal-directed care to reduce loss of brain-dead potential donors to cardiac arrest is unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the effectiveness of an evidence-based, goal-directed checklist in the clinical management of brain-dead potential donors in the intensive care unit (ICU).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>The Donation Network to Optimize Organ Recovery Study (DONORS) was an open-label, parallel-group cluster randomized clinical trial in Brazil. Enrollment and follow-up were conducted from June 20, 2017, to November 30, 2019. Hospital ICUs that reported 10 or more brain deaths in the previous 2 years were included. Consecutive brain-dead potential donors in the ICU aged 14 to 90 years with a condition consistent with brain death after the first clinical examination were enrolled. Participants were randomized to either the intervention group or the control group. The intention-to-treat data analysis was conducted from June 15 to August 30, 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Hospital staff in the intervention group were instructed to administer to brain-dead potential donors in the intervention group an evidence-based checklist with 13 clinical goals and 14 corresponding actions to guide care, every 6 hours, from study enrollment to organ retrieval. The control group provided or received usual care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was loss of brain-dead potential donors to cardiac arrest at the individual level. A prespecified sensitivity analysis assessed the effect of adherence to the checklist in the intervention group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 1771 brain-dead potential donors screened in 63 hospitals, 1535 were included. These patients included 673 males (59.2%) and had a median (IQR) age of 51 (36.3-62.0) years. The main cause of brain injury was stroke (877 [57.1%]), followed by trauma (485 [31.6%]). Of the 63 hospitals, 31 (49.2%) were assigned to the intervention group (743 [48.4%] brain-dead potential donors) and 32 (50.8%) to the control group (792 [51.6%] brain-dead potential donors). Seventy potential donors (9.4%) at intervention hospitals and 117 (14.8%) at control hospitals met the primary outcome (risk ratio [RR], 0.70; 95% CI, 0.46-1.08; <jats:italic>P<\/jats:italic>\u2009=\u2009.11). The primary outcome rate was lower in those with adherence higher than 79.0% than in the control group (5.3% vs 14.8%; RR, 0.41; 95% CI, 0.22-0.78; <jats:italic>P<\/jats:italic>\u2009=\u2009.006).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This cluster randomized clinical trial was inconclusive in determining whether the overall use of an evidence-based, goal-directed checklist reduced brain-dead potential donor loss to cardiac arrest. The findings suggest that use of such a checklist has limited effectiveness without adherence to the actions recommended in this checklist.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\/study\/NCT03179020\">NCT03179020<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.46901","type":"journal-article","created":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T11:02:27Z","timestamp":1702551747000},"page":"e2346901","source":"Crossref","is-referenced-by-count":13,"title":["Evidence-Based Checklist to Delay Cardiac Arrest in Brain-Dead Potential Organ Donors"],"prefix":"10.1001","volume":"6","author":[{"given":"Glauco A.","family":"Westphal","sequence":"first","affiliation":[{"name":"Responsabilidade Social\u2013Programa de Apoio ao Desenvolvimento Institucional do Sistema \u00danico de Sa\u00fade (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil"},{"name":"Central Estadual de Transplantes de Santa Catarina, Rua Esteves J\u00fanior, Florian\u00f3polis, Santa Catarina, Brazil"},{"name":"Centro Hospitalar Unimed Joinville and Hospital Municipal S\u00e3o Jos\u00e9, Joinville, Santa Catarina, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline Cabral","family":"Robinson","sequence":"additional","affiliation":[{"name":"Responsabilidade Social\u2013Programa de Apoio ao Desenvolvimento Institucional do Sistema \u00danico de Sa\u00fade (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia Elis","family":"Giordani","sequence":"additional","affiliation":[{"name":"Responsabilidade Social\u2013Programa de Apoio ao Desenvolvimento Institucional do Sistema \u00danico de Sa\u00fade (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil"},{"name":"Postgraduate Programme in Epidemiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassiano","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Hospital de Cl\u00ednicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil"},{"name":"Universidade Federal de Ci\u00eancias da Sa\u00fade de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriane Isabel","family":"Rohden","sequence":"additional","affiliation":[{"name":"Responsabilidade Social\u2013Programa de Apoio ao Desenvolvimento Institucional do Sistema \u00danico de Sa\u00fade (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna","family":"dos Passos Gimenes","sequence":"additional","affiliation":[{"name":"Responsabilidade Social\u2013Programa de Apoio ao Desenvolvimento Institucional do Sistema \u00danico de Sa\u00fade (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e1tia Moreira","family":"Guterres","sequence":"additional","affiliation":[{"name":"Responsabilidade Social\u2013Programa de Apoio ao Desenvolvimento Institucional do Sistema \u00danico de Sa\u00fade (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itiana Cardoso","family":"Madalena","sequence":"additional","affiliation":[{"name":"Responsabilidade Social\u2013Programa de Apoio ao Desenvolvimento Institucional do Sistema \u00danico de Sa\u00fade (PROADI-SUS), 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