Optimizing ventilatory support of the potential organ donor during evolving brain death: Maximizing lung availability for transplantation*

2006 ◽  
Vol 34 (2) ◽  
pp. 548-549 ◽  
Author(s):  
George M. Matuschak
Keyword(s):  
Brain Death ◽  
Ventilatory Support ◽  
Organ Donor ◽  
Potential Organ Donor

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

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 Identification of separation phenomenon during brain death determination of potential organ donor and analysis of relative factors

2020 ◽  
Vol 7 (5) ◽  
pp. 1347
Author(s):  
Guixing Xu ◽  
Ping Yu ◽  
Ping Xu ◽  
Donghua Zheng
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Brain Death ◽  
Organ Donor ◽  
Respiratory Arrest ◽  
Successful Implementation ◽  
Related Factors ◽  
Potential Organ Donor ◽  
Brain Death Determination ◽  
Death Determination

Background: With analyzing the incongruent phenomenon of electrical active and cerebral blood flow in brain death determination and screening the related factors, offer correct explanations and countermeasure to ensure the successful implementation of donation after brain death.Methods: Relevant clinical data of potential brain death organ donors were prospectively collected between June 2018 and May 2019. The related parameters of neurological examination, laboratory examination and neuroimaging examination during the period of brain death determination were dynamically recorded. Separation phenomenon was used as grouping factors to screen the factors related to separation phenomena through univariate and multivariate analysis.Results: According to the inclusion criteria, 127 patients were included in the study. Among 22 patients (17.3%) with incongruent phenomenon, 17 (77.3%) had electrical silence earlier than cerebral blood flow arrest, and 9 (22.7%) had cerebral blood flow arrest earlier than electrical silence. Univariate and multivariate analysis showed that age <14 years (OR=6.25, 95%CI 1.21-32.22, p=0.028),  SBP≥140 mmHg (OR=7.43, 95%CI 1.62-33.99, p=0.010), primary brainstem injury (OR=15.89, 95%CI 3.04-82.93, p=0.006), spontaneous respiratory arrest time ≤72 hours (OR=11.96, 95%CI 1.59-89.78, p=0.009) and decompression craniotomy(unilateral or bilateral) (OR=16.28, 95%CI 2.25-117.73, p=0.001) were associated with separation phenomenon..Conclusions: Separation phenomenon is a common during the confirmation test of brain death determination in China, and should be correctly recognized. To adopt corresponding measures according to risk factors is useful for successful implementation of donation after 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.

scholarly journals Anaesthetic management of ASA 6 patients

2016 ◽  
Vol 63 (2) ◽  
pp. 75-77 ◽  
Author(s):  
Marijana Zivkovic ◽  
Vanja Misic ◽  
Mirjana Lausevic ◽  
Miodrag Milenovic ◽  
Branislava Stefanovic
Keyword(s):  
Intensive Care ◽  
Brain Death ◽  
Organ Donor ◽  
Serum Levels ◽  
Anaesthetic Management ◽  
Hemodynamic Stability ◽  
Potential Organ Donor ◽  
Brain Functions ◽  
Acid Base Status ◽  
The Stability

The criteria to determine brain death include circulatory-respiratory criteria-loss of circulation and respiration and neurological criteria - irreversible cessation of all brain functions. After brain death is proven, intensive care is directed from nonspecific neuroprotection to somatic organs protection. Access to the maintenance of the potential organ donor began achieving rapid hemodynamic stability with the monitoring and correction of serum levels of electrolytes, glucose and lactate, acid-base status, determining and maintaining body temperature-deceased patients with a beating heart are poikilothermic and their temperature depends of the surrounding temperature and analysis accompanying comorbidity and its possible impact, especially on the stability of the cardiovascular system. The result of intensive care and good maintenance of these patients are good quality organs for transplant.

Ethical Concerns and Care Before Organ Donation

2019 ◽  
pp. 1012-1014
Author(s):  
Diane C. McLaughlin ◽  
Lauren K. Ng Tucker
Keyword(s):  
Critical Care ◽  
Brain Death ◽  
Organ Donation ◽  
Cardiac Death ◽  
Family Members ◽  
Organ Donor ◽  
Donation After Cardiac Death ◽  
Potential Organ Donor ◽  
Ethical Concerns

Organ donation usually proceeds smoothly and compassionately without raising any ethical concerns, and the involved family members are usually very satisfied. When concerns do arise, they typically involve 3 issues: consent for organ donation, critical care of the potential organ donor with brain death, and donation after cardiac death.

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