Brain Death and Management of the Heart-Beating, Brain-Dead Organ Donor

2001 ◽  
pp. 449-455
Author(s):  
Paul Ellis Marik
Keyword(s):  
Brain Death ◽  
Organ Donor ◽  
Heart Beating ◽  
Brain Dead

Brain Death and Resuscitation of the Organ Donor

2017 ◽  
Author(s):  
Kasra Khatibi ◽  
Chitra Venkatasubramanian
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Brain Death ◽  
Organ Donor ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Potential Organ Donor ◽  
Brain Dead ◽  
Donor After Brain Death ◽  
Apnea Testing

When is a patient brain dead? Under what scenarios in the surgical intensive care unit is brain death a possibility? Who can declare brain death and how? What are the steps after brain death declaration? You will find answers to all of these and more in this review. We will walk you through the principles, prerequisites, and techniques of clinical brain death evaluation using checklists and videos. The role and interpretation of ancillary testing and pitfalls are also discussed. New in this section is a description of the techniques that can be adapted when a patient is on extracorporeal membrane oxygenation. In addition, we have included a section on how to communicate effectively (i.e., what phrases to use) with families while discussing brain death and thereby avoid conflicts. We conclude with a detailed section on the physiology and critical care of the potential organ donor after brain death. This review contains 2 videos, 8 figures, 3 tables and 21 references Key words: Brain death, Apnea testing, ECMO, Organ donation

Donor organ management

2021 ◽  
pp. 691-705
Author(s):  
Arne P Neyrinck ◽  
Patrick Ferdinande ◽  
Dirk Van Raemdonck ◽  
Marc Van de Velde
Keyword(s):  
Brain Death ◽  
Treatment Strategies ◽  
Organ Donor ◽  
Hormonal Changes ◽  
Physiological Changes ◽  
Donor Pool ◽  
Potential Donor ◽  
Donor Management ◽  
Heart Beating ◽  
Pituitary Thyroid Axis

Organ transplantation is the standard treatment modality for end-stage organ disease in selected cases. Two types of potential organ donors can be identified: the brain-dead 'heart-beating donors', referred to as DBD (donation after brain death), and the warm ischaemic 'non-heart-beating donors', referred to as DCD (donation after circulatory death). Brain death induces several physiological changes in the DBD donor. An autonomic storm is characterized by massive catecholamine release, followed by autonomic depletion during a vasoplegic phase. This is associated with several hormonal changes (suppression of vasopressin, the hypothalamic-pituitary-adrenal axis, and the hypothalamic-pituitary-thyroid axis) and an inflammatory response. These physiological changes form the basis of organ donor management, including cardiovascular stabilization and hormonal therapy (including vasopressin and analogues, thyroid hormone, and cortisol). Donor management is the continuation of critical care, with a shift towards individual organ stabilization. An aggressive approach to maximize organ yield is recommended; however, many treatment strategies need further investigation in large randomized trials. DCD donors have now evolved as a valid alternative to increase the potential donor pool and challenge the clinician with new questions. Optimal donor comfort therapy and end-of-life care are important to minimize the agonal phase. A strict approach towards the determination of death, based on cardiorespiratory criteria, is prerequisite. Novel strategies have been developed, using ex situ organ perfusion as a tool, to evaluate and recondition donor organs. They might become more important in the future to further optimize organ quality.

Diagnosis of brain death and management of brain dead organ donor

2014 ◽  
Vol 11 (2) ◽  
pp. 122-125
Author(s):  
Sanjith Saseedharan ◽  
Vaibhav Kubal
Keyword(s):  
Brain Death ◽  
Organ Donor ◽  
Brain Dead

Physiologic Features of Brain Death

2017 ◽  
Vol 83 (8) ◽  
pp. 850-854 ◽  
Author(s):  
Eno-Obong Essien ◽  
Kristina Fioretti ◽  
Thomas M. Scalea ◽  
Deborah M. Stein
Keyword(s):  
Brain Death ◽  
Injury Severity ◽  
Organ Donor ◽  
Respiratory Dysfunction ◽  
Traumatic Injuries ◽  
Potential Organ Donor ◽  
Major Mechanism ◽  
Patient Demographics ◽  
Widespread Belief ◽  
Brain Dead

Brain death is known to be associated with physiologic derangements but their incidence is poorly described. Knowledge of the changes that occur during brain death is important for management of the potential organ donor. Thus, we sought to characterize the pathophysiology that occurs during brain death in patients with traumatic injuries. All brain-dead patients over a 10-year period were identified from the trauma registry at a level 1 urban trauma center. Patient demographics, injury characteristics, and clinical data for defining organ dysfunction were reviewed for the 24 hours surrounding brain-death declaration. Three hundred and seventy-three patients were identified. Mean age was 37 years (617.2). Seventy-five per cent were male. Major mechanism of injury was blunt trauma in 66 per cent. Median injury severity score was 34 (IQR 25–43) with a median head abbreviated injury scale score of 5. The most common physiological disturbance was hypotension with 91 per cent of subjects requiring vasopressors. Thrombocytopenia and acidosis both had an incidence of 79 per cent. The next most common disturbances were hypothermia and moderate-to-severe respiratory dysfunction in 62 per cent. Myocardial injury was seen in 91 per cent but only 5.7 per cent of patients manifested severe cardiac dysfunction with an ejection fraction of <35. Diabetes insipidus was diagnosed in 50 per cent of patients. Interestingly, coagulopathy was noted in only 61.3 per cent, and hyperglycemia was seen in 36 per cent despite widespread belief that these occur universally during brain death. This is the first and largest study to characterize the incidence of pathophysiological disturbances following brain death in humans. Appropriate management of these dysfunctions is important for support of potential brain-dead organ donors.

scholarly journals Implementing of Active Brain-Dead Donor Identification Strategy in a Single Donor Center: One Year Experience

Medicina ◽  
2020 ◽  
Vol 56 (8) ◽  
pp. 366
Author(s):  
Akvilina Trilikauskienė ◽  
Irena Maraulaitė ◽  
Diana Damanskytė ◽  
Dovilė Lukminaitė ◽  
Neringa Balčiūnienė ◽  
...  
Keyword(s):  
Brain Death ◽  
Search Strategy ◽  
Organ Donor ◽  
Donor Center ◽  
Donor Pool ◽  
Donor Identification ◽  
Brain Dead ◽  
One Year ◽  
Brain Dead Donor ◽  
Identification Strategy

Background and objectives: Organ shortage is considered to be a major limitation for increasing transplantation rates. Brain-dead donors (DBDs) are an important source of organs, but up to 50% of potential DBDs might not be identified. An active brain-dead donor search could potentially increase a deceased donor pool. The aim of this study was to evaluate the effectiveness of an active potential DBD identification program and to evaluate one year impact on the potential organ donor pool in Lithuania‘s biggest medical institution. Materials and Methods: An organ donor coordinator service was established and active DBD search strategy was implemented in the hospital of LSMU Kauno Klinikos, and retrospective data analysis was performed between December 2016 and December 2017. Collected data was compared to the available data of the previous year in the same center and to the donation dynamics of the whole country. Results: A total of 6734 patients were treated in all intensive care units (ICU), and 234 (3.5%) of them were identified as possible donors. No increase in potential donor’s number was observed in study year (n = 34) compared to remote year (n = 37). No significant difference in potential donor’s demographic data, cause of death, family refusals and medical contraindication rates. Cerebral angiography (CA) repeated in 20% of potential donors in order to confirm brain death diagnosis. More potential donors for whom CA was repeated had decompressive craniectomy done (66.7% vs. 33.3%, p = 0.018). Decompressive craniectomy statistically significantly increases the rate of repeated CA (OR 12.7; 95% CI, 1.42–113.37; p = 0.023). Active search strategy increased length of hospital stay of potential donors comparing to previous year (3.97 ± 4.73 vs. 2.51 ± 2.63, p = 0.003). An optimal time of the first four days of hospitalization to identify a potential donor was observed during our study (OR 10.42; 95% CI, 4.29–25.34; p = 0.001). Conclusions: We were not able to demonstrate active donor identification strategy superiority over the passive strategy during a short one year period; nevertheless, valuable knowledge was gained in brain death diagnostics, new terminology was implemented, and the stability of actual donor numbers was observed in the experimental donor center in the light of decreasing national results. Long-term strategy is required to achieve sustainable results in organ donation.

scholarly journals Imminent brain death: point of departure for potential heart-beating organ donor recognition

2010 ◽  
Vol 36 (9) ◽  
pp. 1488-1494 ◽  
Author(s):  
Yorick J. de Groot ◽  
Nichon E. Jansen ◽  
Jan Bakker ◽  
Michael A. Kuiper ◽  
Stan Aerdts ◽  
...  
Keyword(s):  
Brain Death ◽  
Organ Donor ◽  
Heart Beating ◽  
Point Of Departure

Organ Donation, Brain Death and the Family: Valid Informed Consent

2015 ◽  
Vol 43 (2) ◽  
pp. 369-382 ◽  
Author(s):  
Ana S. Iltis
Keyword(s):  
Informed Consent ◽  
Brain Death ◽  
Organ Donation ◽  
Organ Procurement ◽  
Organ Donor ◽  
Public Understanding ◽  
Organ Procurement Organization ◽  
The Family ◽  
Driver's License ◽  
Brain Dead

In July 2013, parents in Ohio objected to their 21-year-old son becoming an organ donor. Elijah Smith was involved in an accident and pronounced dead using neurological criteria. The organ procurement organization (OPO) went to court and argued that because the young man was brain dead and because his driver's license indicated that he wished to be a donor, the court should allow them to use his organs. The mother argued that her son did not understand what he was signing when he signed his license and that his signature did not reflect an informed decision. The court disagreed with her, saying that he had indicated a wish to donate his organs and that no one but Elijah could revoke that wish. His organs were removed.Elijah's mother suspected that he did not understand what he was signing. She might have been right, given what we know about the process for obtaining permission for organ donation and the limited public understanding of brain death.

scholarly journals When Life Ceases—Relatives’ Experiences When a Family Member Is Confirmed Brain Dead and Becomes a Potential Organ Donor—A Literature Review

2020 ◽  
Vol 6 ◽  
pp. 237796082092203
Author(s):  
Birgitta Kerstis ◽  
Margareta Widarsson
Keyword(s):  
Literature Review ◽  
Brain Death ◽  
Family Member ◽  
Healthcare Professionals ◽  
Organ Donor ◽  
Essential Information ◽  
Potential Organ Donor ◽  
Donation Process ◽  
Brain Dead ◽  
Meta Analyses

Introduction Most healthcare professionals rarely experience situations of a request for organ donation being made to the patient’s family and need to have knowledge and understanding of the relatives’ experiences. Objective To describe relatives’ experiences when a family member is confirmed brain dead and becomes a potential organ donor. Methods A literature review and a thematic data analysis were undertaken, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting process. A total of 18 papers, 15 qualitative and 3 quantitative, published from 2010 to 2019, were included. The electronic search was carried out in January 2019. Results The overarching theme When life ceases emerged as a description of relatives’ experiences during the donation process, including five subthemes: cognitive dissonance and becoming overwhelmed with emotions, interacting with healthcare professionals, being in a complex decision-making process, the need for proximity and privacy, and feeling hope for the future. The relatives had different needs during the donation process. They were often in shock when the declaration of brain death was presented, and the donation request was made, which affected their ability to assimilate and understand information. They had difficulty understanding the concept of brain death. The healthcare professionals caring for the patient had an impact on how the relatives felt after the donation process. Furthermore, relatives needed follow-up to process their loss. Conclusion Caring science with an explicit relative perspective during the donor process is limited. The grief process is individual for every relative, as the donation process affects relatives’ processing of their loss. We assert that intensive care unit nurses should be included when essential information is given, as they often work closest to the patient and her or his family. Furthermore, the relatives need to be followed up afterwards, in order to have questions answered and to process the grief, together with healthcare professionals who have insight into the hospital stay and the donation process.

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