Guidelines for Maintenance of Adult Patients With Brain Death and Potential for Multiple Organ Donations: The Task Force of the Brazilian Association of Intensive Medicine the Brazilian Association of Organs Transplantation, and the Transplantation Center of Santa Catarina

• Published in: Transplantation proceedings Vol. 44; no. 8; pp. 2260 - 2267
• Main Authors: Westphal, G.A, Caldeira Filho, M, Fiorelli, A, Vieira, K.D, Zaclikevis, V, Bartz, M, Wanzuita, R, Teixeira, C, Franke, C, Machado, F.O, Friedman, G, Andrade, J, Matos, J.D, Lamgaro, D.M, Silva, E, Costa, G, Coelho, M.E, Oliveira, M.C, Youssef, N.C.M, Akamine, N, Duarte, P, Lisboa, R, Mazzali, M, Ferraz Neto, B.H
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.10.2012; Elsevier
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biomarkers - blood; Blood Pressure; Blood Pressure Determination - standards; Blood Volume; Body Temperature; Brain Death - blood; Brain Death - diagnosis; Brain Death - physiopathology; Brazil; Carbon Dioxide - blood; Cardiotonic Agents - therapeutic use; Clinical death. Palliative care. Organ gift and preservation; Critical Care - standards; Echocardiography - standards; Erythrocyte Transfusion - standards; Evidence-Based Medicine; Fluid Therapy - standards; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Intracranial Pressure; Lactic Acid - blood; Medical sciences; Organ Transplantation - standards; Oxygen - blood; Rewarming - standards; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tissue and Organ Harvesting - standards; Tissue and Organ Procurement - standards; Tissue Donors - supply & distribution; Tissue Survival; Tissue, organ and graft immunology; Vasoconstrictor Agents - therapeutic use; South America; Brazil; America; Human; Center; Multiple; Task force; Brain death; Transplantation; Maintenance; Homotransplantation; Recommendation; Medicine; Ethics; Organ donation; Association; Treatment; Surgery; Working group; Adult; Graft; Organ
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2012.07.019

Abstract Introduction The organ shortage for transplantation, the principal factor that increases waiting lists, has become a serious public health problem. In this scenario, the intensivist occupies a prominent position as one of the professionals that first has a chance to identify brain death and to be responsible for the maintenance of the potential deceased donor. Objective This report attempts to establish guidelines for care and maintenance of adult deceased donor organs guiding and standardizing care provided to patients with brain death. Method These guidelines were composed by intensivists, transplant coordinators, professionals from various transplant teams, and used transplant center. The formulated questions were forwarded to all members and recommendations were constructed after an extensive literature review selecting articles with the highest degree of evidence. Results Guidelines were developed in the form of questions reflecting frequent experiences in clinical intensive care practices. The main questions were: Is there an optimal interval for keeping organs of deceased donors viable? What actions are considered essential for maintaining deceased donors in this period? What are the limits of body temperature? How should the patient be warmed? Which laboratory tests should be performed? What is the collection interval? What are the limits in the laboratory and the capture scenario? What are the limits of blood pressure? When and how should one use catecholamines? Conclusions This pioneer project involved a multidisciplinary team working in organ transplantation seeking to provide treatment guidance to increase the number of viable organs from deceased adult donors.