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.

Donor organ management

2015 ◽  
Author(s):  
Arne P Neyrinck ◽  
Patrick Ferdinande ◽  
Dirk Van Raemdonck ◽  
Marc Van de Velde
Keyword(s):  
Brain Death ◽  
Treatment Strategies ◽  
Ex Situ ◽  
Hormonal Changes ◽  
Physiological Changes ◽  
Donor Pool ◽  
Potential Donor ◽  
Donor Management ◽  
Aggressive Approach ◽  
Heart Beating

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.

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.

Non-Heart Beating Organ Donation: A Case Study

2005 ◽  
Vol 15 (11) ◽  
pp. 467-475
Author(s):  
John Stirling
Keyword(s):  
Organ Donation ◽  
Clinical Assessment ◽  
Clinical Management ◽  
Organ Donor ◽  
Potential Donor ◽  
Heart Beating ◽  
Donation Process ◽  
Donor Transplant

The aim of this case study is to discuss the clinical management of a non-heart beating organ donor. This case study will concentrate in particular on the clinical assessment of the potential donor patient undertaken by the donor transplant coordinator (DTC) and the donation process up to the time of transplantation. The author will also describe the differences between heart beating and non-heart beating donors and discuss how transplantation can benefit renal recipient patients.

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

The Physician's Perspective: A Survey of Attitudes toward Organ Donor Management

1997 ◽  
Vol 7 (2) ◽  
pp. 55-58
Author(s):  
Lori Coleman-Musser
Keyword(s):  
United States ◽  
Brain Death ◽  
Organ Donor ◽  
The United States ◽  
Donor Management ◽  
Donation Process ◽  
Personal Attitudes ◽  
Physician’S Perspective ◽  
Organ Donor Management ◽  
Diagnosis Of Death

The demand for suitable organs in the United States greatly outweighs the supply of transplantable organs. It has been estimated that approximately half of all potential donors do not donate. Preexisting barriers seem to impede donation, and the physician is a vital link in this process. To better understand the physician's perspective and to identify barriers that may produce difficulties in the process, a survey of physicians in northern Ohio was conducted. Respondents identified the following barriers: consensus in tests performed in the diagnosis of death is lacking, ambivalence exists with respect to informing families of the patient's death and offering families the donation option, and physicians do not seem to recognize the importance of decoupling the discussion of brain death from the request for organs. Although physicians surveyed were in favor of donation and transplantation, an effort should be made to increase awareness in personal attitudes that may affect the donation process.

Procurement after Brain Death

2017 ◽  
Author(s):  
Eelco F.M. Wijdicks
Keyword(s):  
Brain Death ◽  
Medical Management ◽  
Organ Procurement ◽  
Organ Donor ◽  
Close Monitoring ◽  
Physiological Changes ◽  
Organ Perfusion ◽  
The Family ◽  
Brain Dead ◽  
Transplantation Coordinators

This chapter discusses the practice of organ procurement, including the family’s, physician’s, and organ procurement organization’s roles in this process. Procurement of donated organs is a major clinical undertaking requiring close monitoring and treatment by transplantation coordinators. Most importantly, consent for organ donation is discussed with the family, after the patient has been declared brain dead, and this chapter provides a thorough summary of these discussions. There are many physiological challenges to maintaining the viability of the organ donor, and these are discussed in detail. Each of the major physiological derangements and respective care are discussed. Medical management of the donor is aimed at anticipating the normal physiological changes with brain death and achieving optimal organ perfusion and minimizing ischemic injury.

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