Donor management of brain death

Öz

Donor management, recently described as “organ management”, is composed by the treatment of the patients diagnosed with brain death in the intensive care unit. In the brain death, hemodynamic, hormonal and inflammatory disorders resulted in cardiac arrest of the donor candidate can be seen. Unless these disorders be treated, the number and the quality of the organs transplanted may decreased. Also, which organ is planned to be transplanted, treatment and care should be directed to this organ. These disorders having different importances were investigated by the recent literature.

Anahtar Kelimeler

• Brain death,donors,critical care

Beyin ölümünde donör bakımı

Öz

Donör bakımı, son yıllarda “organ yönetimi” olarak adlandırılan yoğun bakımda beyin ölümü tanısı konulmuş hastalara uygulanan tedaviden oluşur. Beyin ölümünde donör adayının kardiak arrestine yol açabilecek hemodinamik, hormonal ve inflamatuvar bozukluklar görülebilir. Bu bozukluklar tedavi edilmezse transplante edilebilecek organ sayısı ve kalitesi düşebilir. Ayrıca donör bakımında hangi organın transplante edilmesi planlanıyorsa ona yönelik tedavi ve bakım uygulanmalıdır. Her biri ayrı öneme sahip bu bozukluklar son literatür taranarak incelenmiştir. 

Anahtar Kelimeler

• beyin ölümü,dönörler,yoğun bakım

Kaynakça

1. KAYNAKLAR1. Xia VW, Braunfeld M. Anesthesia Management of Organ Donors. Anesthesiol Clin. 2017 Sep;35(3):395-406. doi: 10.1016/j.anclin.2017.04.003.
2. 2. Chamorro-Jambrina C, Muñoz-Ramírez MR et al. Organ donor management: Eight common recommendations and actions that deserve reflection. Med Intensiva. 2017 Dec;41(9):559-568. doi: 10.1016/j.medin.2017.01.012.
3. 3. Domínguez-Roldán JM, García-Alfaro C et al. Muerte encefálica: repercusión sobre órganos y tejidos. Med Intensiva. 2009;33:434---41.
4. 4. Souter MJ, Eidbo E. et al. Organ Donor Management: Part 1. Toward a Consensus to Guide Anesthesia Services During Donation After Brain Death. Semin Cardiothorac Vasc Anesth. 2018 Jun;22(2):211-222. doi: 10.1177/1089253217749053.
5. 5. Shemie SD, Ross H. et al. Organ donor management in Canada: recommendations of the forum on medical management to optimize donor organ potential. Can Med Assoc J 2006; 174: S13–30
6. 6. Wood KE,Becker BN et al. Care of the potential donor. N Engl J Med. 2004;351:2730---9.
7. 7. Audibert G, Charpentier C. et al. Improvement of donor myocardial function after treatment of autonomic storm during brain death. Transplantation. 2006;82:1031---6.
8. 8. Bugge JF. Brain death and its implications for management of the potential organ donor. Acta Anaesthesiol Scand. 2009;53:1239---50.

9. 9. Mascia L, Mastromauro I et al. Management to optimize organ procurement in brain dead donors. Minerva Anestesiol. 2009;75:125---33.
10. 10.Dictus C, Vienenkoetter B. et al. Critical care management of potential organ donors: our current standard. Clin Transpl. 2009;23:2---9.
11. 11.Dikdan GS, Mora-Esteves C. et al. Review of randomized clinical trials of donor management and organ preservation in deceased donors: opportunities and issues. Transplantation. 2012;94:425---41.
12. 12. Plurad DS, Bricker S. et al. Arginine vasopressin significantly increases the rate of successful organ procurement in potential donors. Am J Surg. 2012;204:856---60.
13. 13. Cuende N, Miranda B, Ca˜nón JF, Garrido G, Matesanz R. Donor characteristics associated with liver graft survival. Transplanta tion. 2005;79:1445---52.
14. 14. Malinoski DJ, Daly MC. et al. Achieving donor management goals before deceased donor procurement is associated with more organs transplanted per donor. J Trauma. 2011 Oct;71(4):990-5; discussion 996. doi: 10.1097/TA.0b013e31822779e5.
15. 15. Venkateswaran RV, Patchell VB et al. Early donor management increases the retrieval rate of lungs for transplantation. Ann Thorac Surg. 2008 Jan;85(1):278-86.16. de Perrot M, Weder W et al. Strategies to increase limited donor resources. Eur Respir J. 2004 Mar;23(3):477-82.
16. 17. Zaroff JG, Rosengard BR, Armstrong WF, et al: Consensus conference report: Maximizing use of organs recovered from the cadaver donor: Cardiac recommendations, March 2829, 2001, Crystal City, Va. Circulation 2002; 106:836–841.
17. 18. Kotloff RM, Blosser S. et al. Management of the potential organ donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement. Crit Care Med. 2015;43:1291---325.
18. 19. Macdonald P S., Aneman A. et al. A systematic review and meta-analysis of clinical trials of thyroid hormone administration to brain dead potential organ donors. Crit Care Med 2012: 40;5: 1635-44.
19. 20. Pinsard M, Ragot S. et al. Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study. Crit Care. 2014 Jul 23;18(4):R158. doi: 10.1186/cc13997.
20. 21. Mangus RS, Fridell JA, Vianna RM, et al. Severe hypernatremia in deceased liver donors does not impact early transplant outcome. Transplantation 2010; 90: 438–43.
21. 22. Sally MB, Ewing T. et al. Determining optimal threshold for glucose control in organ donors after neurologic determination of death: a United Network for Organ Sharing Region 5 Donor Management Goals Workgroup prospective analysis. J Trauma Acute Care Surg. 2014;76:62---8.
22. 23. Niemann CU, Feiner J. et al. Therapeutic hypothermia in deceased organ donors and kidney-graft function. N Engl J Med. 2015;373:405---14.
23. 24. Hergenroeder GW, Ward NH et al. Randomized trial to evaluate nutritional status and absorption of enteral feeding after brain death. Prog Transpl. 2013;23:374---82.
24. 25. Zaroff JG, Rosengard BR et al. Consensus conference report: maximizing use of organs recovered from the cadaver donor: cardiac recommendations, March 28-29, 2001, Crystal City, Va. Circulation. 2002 Aug 13;106(7):836-41.
25. 26. Pennefather S. Hemodynamic responses to noxious stimuli in brain-dead organ donors. Intensive Care Med 1994; 20: 165–6.
26. 27. McKeown DW, Bonser RS et al. Management of the heartbeating brain-dead organ donor. Br J Anaesth. 2012 Jan;108 Suppl 1:i96-107. doi: 10.1093/bja/aer351.