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

Transplantation Journal ◽

10.1097/00007890-199501150-00011 ◽

1995 ◽

Vol 59 (1) ◽

pp. 58-62 ◽

Cited By ~ 113

Author(s):

Stephen H. Pennefather ◽

Robert E. Bullock ◽

David Mantle ◽

John H. Dark

Keyword(s):

Arginine Vasopressin ◽

Low Dose ◽

Organ Donors ◽

Brain Dead

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Organ Donation and Declaration of Death: Combined Neurologic and Cardiopulmonary Standards

The Linacre Quarterly ◽

10.1177/0024363919840129 ◽

2019 ◽

Vol 86 (4) ◽

pp. 285-296

Author(s):

Stephen E. Doran ◽

Joseph M. Vukov

Keyword(s):

Brain Death ◽

Organ Donation ◽

Conflict Of Interest ◽

Life Support ◽

Organ Procurement ◽

Organ Donors ◽

Neurologic Injury ◽

Brain Dead ◽

Moral Certainty ◽

Death By Neurologic Criteria

Prolonged survival after the declaration of death by neurologic criteria creates ambiguity regarding the validity of this methodology. This ambiguity has perpetuated the debate among secular and nondissenting Catholic authors who question whether the neurologic standards are sufficient for the declaration of death of organ donors. Cardiopulmonary criteria are being increasingly used for organ donors who do not meet brain death standards. However, cardiopulmonary criteria are plagued by conflict of interest issues, arbitrary standards for candidacy, and the lack of standardized protocols for organ procurement. Combining the neurological and cardiopulmonary standards into a single protocol would mitigate the weaknesses of both and provide greater biologic and moral certainty that a donor of unpaired vital organs is indeed dead. Summary: Before a person’s organs can be used for transplantation, he or she must be declared “brain-dead.” However, sometimes when someone is declared brain-dead, that person can be maintained on life-support for days or even weeks. This creates some confusion about whether the person has truly died. For patients who have a severe neurologic injury but are not brain-dead, organ donation can also occur after his or her heart stops beating. However, this protocol is more ambiguous and lacks standardized protocols. We propose that before a person can donate organs, he or she must first be declared brain-dead, and then his or her heart must irreversibly stop beating before organs are taken.

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Pathophysiological Changes and Systemic Inflammation in Brain Dead Organ Donors: Effect on Graft Quality

10.5772/intechopen.94360 ◽

2020 ◽

Author(s):

Neva Bezeljak ◽

Željka Večerić-Haler

Keyword(s):

Brain Death ◽

Organ Damage ◽

Active Management ◽

Definitive Treatment ◽

Organ Donors ◽

Brain Functions ◽

Brain Dead ◽

End Stage ◽

Irreversible Cessation

Transplantation is the definitive treatment of end-stage organ disease. As the shortage of suitable organs poses its main limitation, the active management of potential organ donors becomes increasingly more important. The majority of solid organs are still obtained from donors after confirmed brain death. Brain death is the complete and irreversible cessation of all brain functions, and triggers a variety of severe pathophysiological changes in cardiovascular, hormonal and metabolic status that can result in organ damage. Moreover, brain death is associated with massive inflammatory response with a cytokine storm and complement activation that increases graft immunogenicity and adversely affects graft survival. Organs from brain-dead donors are more prone to graft dysfunction and rejection when compared to organs obtained from living donors. Brain death is thus believed to be an important risk factor influencing the quality of organs before procurement.

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Correlation of brain-dead organ donors’ age and time period between admission and the first brain death examination: 5 years data of Korea

Korean Journal of Transplantation ◽

10.4285/atw2020.op-1055 ◽

2020 ◽

Vol 34 (1) ◽

pp. S194-S194

Author(s):

Eun-sil Jeong ◽

A. S. M. Tanim Anwar ◽

Jae-myeong Lee

Keyword(s):

Brain Death ◽

Organ Donors ◽

Time Period ◽

Brain Dead

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Safety and effectiveness of kidney transplantation using a donation after brain death donor with acute kidney injury: a retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-84977-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kyeong Deok Kim ◽

Kyo Won Lee ◽

Sang Jin Kim ◽

Okjoo Lee ◽

Manuel Lim ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Transplantation ◽

Brain Death ◽

Graft Survival ◽

Low Dose ◽

Kidney Injury ◽

Induction Agent ◽

Donor Pool ◽

Donation After Brain Death

AbstractThe use of kidneys from donation after brain death (DBD) donors with acute kidney injury (AKI) is a strategy to expand the donor pool. The aim of this study was to evaluate how kidney transplantation (KT) from a donor with AKI affects long-term graft survival in various situations. All patients who underwent KT from DBD donors between June 2003 and April 2016 were retrospectively reviewed. The KDIGO (Kidney Disease: Improving Global Outcomes) criteria were used to classify donor AKI. The cohort included 376 donors (no AKI group, n = 117 [31.1%]; AKI group n = 259 [68.9%]). Death-censored graft survival was similar according to the presence of AKI, AKI severity, and the AKI trend (p = 0.929, p = 0.077, and p = 0.658, respectively). Patients whose donors had AKI who received using low dose (1.5 mg/kg for three days) rabbit anti-thymocyte globulin (r-ATG) as the induction agent had significantly superior death-censored graft survival compared with patients in that group who received basiliximab (p = 0.039). AKI in DBD donors did not affect long-term death-censored graft survival. Low-dose r-ATG may be considered as an induction immunosuppression in recipients receiving kidneys with AKI because it showed better graft survival than basiliximab.

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