scholarly journals Perioperatives Management der postmortalen Organspende

2021 ◽  
Author(s):  
Jan Sönke Englbrecht ◽  
Christian Lanckohr ◽  
Christian Ertmer ◽  
Alexander Zarbock
Keyword(s):  
Organ Procurement ◽  
Perioperatives Management ◽  
Randomisierte Studien ◽  
Ethical Considerations ◽  
Donor Organ ◽  
Donor Management ◽  
Evidenzbasierte Empfehlungen ◽  
Ethische Aspekte ◽  
Brain Dead ◽  
Brain Dead Donor

Zusammenfassung Hintergrund Die Anzahl postmortal gespendeter Organe ist in Deutschland weit geringer als der Bedarf. Dies unterstreicht die Wichtigkeit einer optimalen Versorgung während des gesamten Prozesses der Organspende. Fragestellung Es existieren internationale Leitlinien und nationale Empfehlungen zu intensivmedizinischen organprotektiven Maßnahmen beim Organspender. Für das anästhesiologische Management fehlen evidenzbasierte Empfehlungen. Ziel dieser Übersichtsarbeit ist es, anhand der vorhandenen Evidenz die pathophysiologischen Veränderungen des irreversiblen Hirnfunktionsausfalls zu rekapitulieren und sich kritisch mit den empfohlenen Behandlungsstrategien und therapeutischen Zielgrößen auseinanderzusetzen. Auch auf ethische Aspekte der Betreuung des postmortalen Organspenders wird eingegangen. Methode Diese Übersichtsarbeit basiert auf einer selektiven Literaturrecherche in PubMed (Suchwörter: „brain dead donor“, „organ procurement“, „organ protective therapy“, „donor preconditioning“, „perioperative donor management“, „ethical considerations of brain dead donor“). Internationale Leitlinien und nationale Empfehlungen wurden besonders berücksichtigt. Ergebnisse Insgesamt ist die Evidenz für optimale intensivmedizinische und perioperative organprotektive Maßnahmen beim postmortalen Organspender sehr gering. Nationale und internationale Empfehlungen zu Zielwerten und medikamentösen Behandlungsstrategien unterscheiden sich teilweise erheblich: kontrollierte randomisierte Studien fehlen. Der Stellenwert einer Narkose zur Explantation bleibt sowohl unter pathophysiologischen Gesichtspunkten als auch aus ethischer Sicht ungeklärt. Schlussfolgerungen Die Kenntnisse über die pathophysiologischen Prozesse im Rahmen des irreversiblen Hirnfunktionsausfalls und die organprotektiven Maßnahmen sind ebenso Grundvoraussetzung wie die ethische Auseinandersetzung mit dem Thema postmortale Organspende. Nur dann kann das Behandlungsteam in dieser herausfordernden Situation sowohl dem Organempfänger als auch dem Organspender und seinen Angehörigen gerecht werden.

scholarly journals A Single-Center Experience with an Intensivist-Led Brain-Dead Donor Management Program

2018 ◽  
Vol 23 ◽  
pp. 828-835 ◽  
Author(s):  
Jin Park ◽  
Na Rae Yang ◽  
Young-Joo Lee ◽  
Kyung Sook Hong
Keyword(s):  
Management Program ◽  
Single Center ◽  
Donor Management ◽  
Single Center Experience ◽  
Brain Dead ◽  
Brain Dead Donor

scholarly journals A multicenter randomized placebo-controlled trial of intravenous thyroxine for heart-eligible brain-dead organ donors

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rajat Dhar ◽  
Dean Klinkenberg ◽  
Gary Marklin
Keyword(s):  
Thyroid Hormone ◽  
Organ Procurement ◽  
Hemodynamic Instability ◽  
Controlled Study ◽  
Primary Study ◽  
Organ Donors ◽  
Donor Management ◽  
Link Type ◽  
Thyroxine Treatment ◽  
Brain Dead

Abstract Background Brain death frequently induces hemodynamic instability and cardiac stunning. Impairments in cardiac performance are major contributors to hearts from otherwise eligible organ donors not being transplanted. Deficiencies in pituitary hormones (including thyroid-stimulating hormone) may contribute to hemodynamic instability, and replacement of thyroid hormone has been proposed as a means of improving stability and increasing hearts available for transplantation. Intravenous thyroxine is commonly used in donor management. However, small controlled trials have not been able to demonstrate efficacy. Methods This multicenter study will involve organ procurement organizations (OPOs) across the country. A total of 800 heart-eligible brain-dead organ donors who require vasopressor support will be randomly assigned to intravenous thyroxine for at least 12 h or saline placebo. The primary study hypotheses are that thyroxine treatment will result in a higher proportion of hearts transplanted and that these hearts will have non-inferior function to hearts not treated with thyroxine. Additional outcome measures are the time to achieve hemodynamic stability (weaning off vasopressors) and improvement in cardiac ejection fraction on echocardiography. Discussion This will be the largest randomized controlled study to evaluate the efficacy of thyroid hormone treatment in organ donor management. By collaborating across multiple OPOs, it will be able to enroll an adequate number of donors and be powered to definitively answer the critical question of whether intravenous thyroxine treatment increases hearts transplanted and/or provides hemodynamic benefits for donor management. Trial registration ClinicalTrials.govNCT04415658. Registered on June 4, 2020

Organ Recovery from an 84-Year-Old Donor: A Case Study

1997 ◽  
Vol 7 (4) ◽  
pp. 211-213
Author(s):  
Wendy Valerius ◽  
David D Lewis
Keyword(s):  
Organ Procurement ◽  
Donor Organ ◽  
Successful Recovery ◽  
Organ Procurement Organizations ◽  
Organ Recovery ◽  
Age Limit ◽  
Brain Dead ◽  
Old Donor ◽  
Financial Issues

To help meet the increasing need for transplantable organs, organ procurement organizations should consider evaluating all brain-dead patients, regardless of the upper age limit. This article outlines the successful recovery and transplantation of the liver of an 84-year-old donor. Organ placement and financial issues involved with the case are also discussed.

Successful Brain Dead Donor Management with CRRT - A Case Report -

2012 ◽  
Vol 27 (4) ◽  
pp. 286 ◽  
Author(s):  
Sang-Hyun Lim ◽  
Young-Joo Lee ◽  
Han Bum Joe ◽  
Jae-Moung Lee ◽  
In-Kyung Lee
Keyword(s):  
Case Report ◽  
Donor Management ◽  
Brain Dead ◽  
Brain Dead Donor

scholarly journals Unexpected cardio‐circulatory arrest during a brain‐dead donor organ retrieval

2021 ◽  
Vol 9 (5) ◽  
Author(s):  
Pei‐Hsing Chen ◽  
Yu‐Shan Shih ◽  
Ching‐Tang Chiu ◽  
Shu‐Chien Huang ◽  
Hsao‐Hsun Hsu
Keyword(s):  
Circulatory Arrest ◽  
Donor Organ ◽  
Organ Retrieval ◽  
Brain Dead ◽  
Brain Dead Donor

Family perspectives on organ and tissue donation for transplantation: A principlist analysis

2017 ◽  
Vol 25 (8) ◽  
pp. 1041-1050
Author(s):  
Marcelo José dos Santos ◽  
Lydia Feito
Keyword(s):  
Organ Donation ◽  
Organ Procurement ◽  
Sao Paulo ◽  
Tissue Donation ◽  
São Paulo ◽  
Ethical Considerations ◽  
Donation Process ◽  
The Family ◽  
Organ Procurement Organizations ◽  
Family Interview

Background: The family interview context is permeated by numerous ethical issues which may generate conflicts and impact on organ donation process. Objective: This study aims to analyze the family interview process with a focus on principlist bioethics. Method: This exploratory, descriptive study uses a qualitative approach. The speeches were collected using the following prompt: “Talk about the family interview for the donation of organs and tissues for transplantation, from the preparation for the interview to the decision of the family to donate or not.” For the treatment of qualitative data, we chose the method of content analysis and categorical thematic analysis. Participants: The study involved 18 nurses who worked in three municipal organ procurement organizations in São Paulo, Brazil, and who conducted family interviews for organ donation. Ethical considerations: The data were collected after approval of the study by the Research Ethics Committee of the School of Nursing of the University of São Paulo. Results: The results were classified into four categories and three subcategories. The categories are the principles adopted by principlist bioethics. Discussion: The principles of autonomy, beneficence, non-maleficence, and justice permeate the family interview and reveal their importance in the organs and tissues donation process for transplantation. Conclusion: The analysis of family interviews for the donation of organs and tissues for transplantation with a focus on principlist bioethics indicates that the process involves many ethical considerations. The elucidation of these aspects contributes to the discussion, training, and improvement of professionals, whether nurses or not, who work in organ procurement organizations and can improve the curriculum of existing training programs for transplant coordinators who pursue ethics in donation and transplantation as their foundation.

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