USE OF LOW DOSE ARGININE VASOPRESSIN TO SUPPORT BRAIN-DEAD ORGAN DONORS

[There are] two policy choices: we can abandon attempts to justify use of anencephalic infants as organ donors because there is currently no clinically accepted means to declare brain death in these infants; or we can carry out the research necessary to establish a clinically valid procedure for doing so. A Canadian group has decided to take the second route and experiment on methods to use as organ donors anencephalic newborns who can be validly declared brain-dead on classic criteria. The group has developed a basic protocol that calls for the parents to agree, prior to birth, that: (1) the infant will be resuscitated; (2) periodic testing will be done to determine brain death (removal from the ventilator at six-to-twelve-hour intervals for a ten-minute period to determine ability to breathe spontaneously; (3) organ donation is acceptable; and (4) a definite time limit (to be determined by the parents but not more than fourteen days) after which the infant will be removed from the ventilator and permitted to die. Low-dose morphine is administered to prevent potential suffering on the part of the infant, although whether anencephalic newborns can suffer is unknown.

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Brazilian guidelines for the management of brain-dead potential organ donors. The task force of the AMIB, ABTO, BRICNet, and the General Coordination of the National Transplant System

Annals of Intensive Care ◽

10.1186/s13613-020-00787-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Glauco Adrieno Westphal ◽

Caroline Cabral Robinson ◽

Alexandre Biasi Cavalcanti ◽

Anderson Ricardo Roman Gonçalves ◽

Cátia Moreira Guterres ◽

...

Keyword(s):

Intensive Care ◽

Body Temperature ◽

Low Dose ◽

Task Force ◽

Graft Function ◽

Red Blood Cell Transfusion ◽

Lung Protective Ventilation ◽

Organ Donors ◽

Protective Ventilation Strategy ◽

Brain Dead

Abstract Objective To contribute to updating the recommendations for brain-dead potential organ donor management. Method A group of 27 experts, including intensivists, transplant coordinators, transplant surgeons, and epidemiologists, joined a task force formed by the General Coordination Office of the National Transplant System/Brazilian Ministry of Health (CGSNT-MS), the Brazilian Association of Intensive Care Medicine (AMIB), the Brazilian Association of Organ Transplantation (ABTO), and the Brazilian Research in Intensive Care Network (BRICNet). The questions were developed within the scope of the 2011 Brazilian Guidelines for Management of Adult Potential Multiple-Organ Deceased Donors. The topics were divided into mechanical ventilation, hemodynamic support, endocrine-metabolic management, infection, body temperature, blood transfusion, and use of checklists. The outcomes considered for decision-making were cardiac arrest, number of organs recovered or transplanted per donor, and graft function/survival. Rapid systematic reviews were conducted, and the quality of evidence of the recommendations was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Two expert panels were held in November 2016 and February 2017 to classify the recommendations. A systematic review update was performed in June 2020, and the recommendations were reviewed through a Delphi process with the panelists between June and July 2020. Results A total of 19 recommendations were drawn from the expert panel. Of these, 7 were classified as strong (lung-protective ventilation strategy, vasopressors and combining arginine vasopressin to control blood pressure, antidiuretic hormones to control polyuria, serum potassium and magnesium control, and antibiotic use), 11 as weak (alveolar recruitment maneuvers, low-dose dopamine, low-dose corticosteroids, thyroid hormones, glycemic and serum sodium control, nutritional support, body temperature control or hypothermia, red blood cell transfusion, and goal-directed protocols), and 1 was considered a good clinical practice (volemic expansion). Conclusion Despite the agreement among panel members on most recommendations, the grade of recommendation was mostly weak. The observed lack of robust evidence on the topic highlights the importance of the present guideline to improve the management of brain-dead potential organ donors.

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Alteration in the Transcriptional Profile of Livers from Brain-dead Organ Donors

Transplantation Journal ◽

10.1097/01.tp.0000225829.07208.58 ◽

2006 ◽

Vol 82 (1) ◽

pp. 69-79 ◽

Cited By ~ 16

Author(s):

Gualtiero Colombo ◽

Stefano Gatti ◽

Flavia Turcatti ◽

Caterina Lonati ◽

Andrea Sordi ◽

...

Keyword(s):

Transcriptional Profile ◽

Organ Donors ◽

Brain Dead

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326 A Randomized Trial of Nebulized Albuterol To Enhance Resolution of Pulmonary Edema in 506 Brain Dead Organ Donors

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2012.01.334 ◽

2012 ◽

Vol 31 (4) ◽

pp. S116 ◽

Cited By ~ 8

Author(s):

L.B. Ware ◽

M. Landeck ◽

T. Koyama ◽

E. Johnson ◽

G.R. Bernard ◽

...

Keyword(s):

Pulmonary Edema ◽

Randomized Trial ◽

Organ Donors ◽

Brain Dead

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Intraoperative Hemodynamic Heterogeneity of Brain Dead Organ Donors

Survey of Anesthesiology ◽

10.1097/00132586-199208000-00063 ◽

1992 ◽

Vol 36 (4) ◽

pp. 268

Author(s):

P. E. DUKE ◽

M. A. E. RAMSAY ◽

A. W. PAULSEN ◽

T. C. GUNNING ◽

L. C. ROBERTS ◽

...

Keyword(s):

Organ Donors ◽

Brain Dead

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Honoring Donor Designation in Brain Dead Organ Donors

Transplantation Journal ◽

10.1097/01.tp.0000524987.47185.52 ◽

2017 ◽

Vol 101 ◽

pp. S13

Author(s):

Susan Larson ◽

Susan Gunderson ◽

Sue Weese

Keyword(s):

Organ Donors ◽

Brain Dead

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Vasopressin Deficiency and Pressor Hypersensitivity In Hemodynamically Unstable Organ Donors

Circulation ◽

10.1161/circ.100.suppl_2.ii-244 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Author(s):

Jonathan M. Chen ◽

Suzanne Cullinane ◽

Talia B. Spanier ◽

John H. Artrip ◽

Ranjit John ◽

...

Keyword(s):

Blood Pressure ◽

Diabetes Insipidus ◽

Low Dose ◽

Clinical Evidence ◽

Pressor Response ◽

Hemodynamic Instability ◽

Solid Organ ◽

Organ Donors ◽

Plasma Vasopressin ◽

Before And After

Background —Solid organ donors often develop hypotension due to vasodilation, and recently we observed that a variety of vasodilatory states are characterized by vasopressin deficiency and hypersensitivity. Thus, we investigated the prevalence of vasopressin deficiency in hypotensive solid organ donors without clinical evidence of diabetes insipidus; we also investigated the vasopressor effect of vasopressin replacement in hypotensive donors. Methods and Results —Fifty organ donors were evaluated for hemodynamic instability, (mean arterial pressure [MAP]≤ 70 mm Hg despite the use of catecholamine vasopressors), and in those unstable donors who were not already receiving exogenous vasopressin, low-dose vasopressin was administered as a continuous infusion (0.04 to 0.1 U/min). MAP, catecholamine requirements, serum vasopressin, and serum osmolality were obtained before and after vasopressin administration. Ten patients meeting the enrollment criteria received vasopressin and MAP increased from 72.2±3.5 to 89.8±4.2 mm Hg, ( P <0.05), allowing for complete discontinuation of catecholamine pressors in 4 (40%) patients and a decrement in pressor dose in 4 (40%). Plasma vasopressin levels (2.9±0.8 pg/mL) were low for the degree of hypotension. Conclusions —Hemodynamically unstable organ donors without clinically apparent diabetes insipidus display a defect in the baroreflex-mediated secretion of vasopressin. In these patients, low-dose vasopressin significantly increases blood pressure with a pressor response sufficient to reduce catecholamine administration.

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Perioperative hemodynamic heterogeneity of brain dead organ donors

Transplant International Official Journal of the European Society for Organ Transplantation ◽

10.1007/978-3-642-77423-2_209 ◽

1992 ◽

pp. 719-721

Author(s):

P. K. Duke ◽

M. A. B. Ramsay ◽

T. C. Gunning ◽

A. W. Paulsen ◽

L. C. Roberts

Keyword(s):

Organ Donors ◽

Brain Dead

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Randomised sham-controlled double-blind trial evaluating remote ischaemic preconditioning in solid organ transplantation: a study protocol for the RIPTRANS trial

BMJ Open ◽

10.1136/bmjopen-2020-038340 ◽

2020 ◽

Vol 10 (11) ◽

pp. e038340

Author(s):

Aki Uutela ◽

Ilkka Helanterä ◽

Karl Lemström ◽

Arie Passov ◽

Simo Syrjälä ◽

...

Keyword(s):

Organ Transplantation ◽

Study Protocol ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Organ Donors ◽

Ischaemic Preconditioning ◽

Study Results ◽

Remote Ischaemic Preconditioning ◽

Brain Dead ◽

Transplanted Organs

IntroductionRemote ischaemic preconditioning (RIPC) using a non-invasive pneumatic tourniquet is a potential method for reducing ischaemia-reperfusion injury. RIPC has been extensively studied in animal models and cardiac surgery, but scarcely in solid organ transplantation. RIPC could be an inexpensive and simple method to improve function of transplanted organs. Accordingly, we aim to study whether RIPC performed in brain-dead organ donors improves function and longevity of transplanted organs.Methods and analysesRIPTRANS is a multicentre, sham-controlled, parallel group, randomised superiority trial comparing RIPC intervention versus sham-intervention in brain-dead organ donors scheduled to donate at least one kidney. Recipients of the organs (kidney, liver, pancreas, heart, lungs) from a randomised donor will be included provided that they give written informed consent. The RIPC intervention is performed by inflating a thigh tourniquet to 300 mm Hg 4 times for 5 min. The intervention is done two times: first right after the declaration of brain death and second immediately before transferring the donor to the operating theatre. The sham group receives the tourniquet, but it is not inflated. The primary endpoint is delayed graft function (DGF) in kidney allografts. Secondary endpoints include short-term functional outcomes of transplanted organs, rejections and graft survival in various time points up to 20 years. We aim to show that RIPC reduces the incidence of DGF from 25% to 15%. According to this, the sample size is set to 500 kidney transplant recipients.Ethics and disseminationThis study has been approved by Helsinki University Hospital Ethics Committee and Helsinki University Hospital’s Institutional Review Board. The study protocol was be presented at the European Society of Organ Transplantation congress in Copenhagen 14−15 September 2019. The study results will be submitted to an international peer-reviewed scientific journal for publication.Trial registration numberNCT03855722.

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