Objective: There is only limited knowledge on the pharmacokinetics of midazolam and its active metabolites in potential organ donors. Before establishing the diagnosis of brain death, drugs interfering with the neurological assessment have to be washed out. National guidelines advise a waiting time of 12 hours. The aim of our study was to evaluate whether it is sufficient to rely on a calculated waiting time.
Methods: As examples of typical pharmacokinetics of midazolam and its metabolites, we followed the concentration over time in four potential organ donors with immunoassays and high-performance liquid chromatography (HPLC).
Results and conclusions: In each of the 4 patients studied, the elimination of midazolam and/or midazolam metabolites was delayed. As long as brain death diagnosis requires that drugs interfering with the clinical assessment must be at levels below the therapeutic range, monitoring of midazolam and metabolites appears mandatory.