Critical care management of potential organ donors: our current standard

• Published in: Clinical transplantation Vol. 23; no. s21; pp. 2 - 9
• Main Authors: Dictus, C., Vienenkoetter, B., Esmaeilzadeh, M., Unterberg, A., Ahmadi, R.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.12.2009; Wiley
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; brain death; Brain Death - physiopathology; Clinical death. Palliative care. Organ gift and preservation; Critical Care - standards; critical care management; Disseminated Intravascular Coagulation - prevention & control; donor candidate; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hemodynamics - physiology; Humans; Medical sciences; pathophysiological considerations; Patient Care Planning; standardized treatment strategies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue Donors; Tissue, organ and graft immunology; Suboptimal donor; Human; Intensive care; donor candidate; Pathophysiology; pathophysiological considerations; standardized treatment strategies; Brain death; Transplantation; Standards; Medicine; Organ donation; Clinical management; Treatment; Surgery; critical care management; Graft; Strategy
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2009.01102.x

:  Caring for a brain dead potential organ donor requires a shift in critical care from the extensive treatment of increased intracranial pressure towards strategies to maintain donor organ function. Suboptimal, unstandardized critical care management of organ donors, however, is one of the main reasons for insufficient organ procurement. The pathophysiological changes following brain death entail a high incidence of complications including hemodynamic instability, endocrine and metabolic disturbances, and disruption of internal homeostasis that jeopardize potentially transplantable organs. Strategies for the management of organ donors exist and consist of the normalization of donor physiology. This has resulted in standardized efforts to improve the critical care delivered to potential organ donors, increasing not only the number, but also the quality of suitable organs and aiming at an optimal outcome for the recipients. In this review, we discuss the pathophysiological changes associated with brain death and present the current guidelines at our department, which are optimized based on available literature.