Management of the multiple organ donor.
ABSTRACT The need for cadaveric organs for transplantation is increasing. This article provides guidelines for the identification of potential organ donors and suggests suitable principles of management. The physiological changes after brain death are briefly reviewed.
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ABSTRACT: Die Transplantation menschlicher Organe ist eine etablierte und meist die einzige lebensrettende Therapie für Patienten im Endstadium eines Organversagens. Derzeit stellt der Mangel an Organen ein großes Problem dar. Die rechtliche Grundlage für eine Transplantation bildet das Transplantationsgesetz (TPG), demzufolge jeder beatmete Patient mit diagnostiziertem Hirntod als potenzieller Organspender in Frage kommt. Im Rahmen des Hirntods kann es zu ausgeprägten Herz-Kreislauf-Reaktionen, Störungen der Thermoregulation, des Wasser- und Elektrolythaushalts, des Endokriniums sowie des Gerinnungssystems kommen. Die organprotektive Therapie beim Spender sowie der Umgang mit dessen Angehörigen stellen besonders hohe Anforderungen an den Intensivmediziner und das Pflegepersonal. For patients with end-stage organ disease transplantation of human organs is a well-established therapy, and in most cases it is the only life-saving one. But the lack of available organs is a big problem. The legal basis in Germany is the transplantation law (TPG). According to this law, every ventilated patient with diagnosed brain death is a potential organ donor. However, brain death may lead to strong reactions in the patient’s cardiovascular system as well as disturbances in thermoregulation, water and electrolyte balance, and the endocrine and haemostatic systems. Thus, protecting the organs of the organ donor and, furthermore, caring for his or her relatives are great challenges for every physician and nurse in the intensive care unit.Der Anaesthesist 12/2007; 56(12):1291-1303. DOI:10.1007/s00101-007-1284-8 · 0.74 Impact Factor
Article: The health of the nationBMJ Clinical Research 08/1991; DOI:10.1136/bmj.303.6797.311-b · 14.09 Impact Factor
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ABSTRACT: Preserving the optimal function of donor organs must be the primary goal of physicians caring for patients who have been certified brain dead and from whom organs will be transplanted. During the hours before organ removal, several significant medical challenges may emerge. These challenges include restoration and maintenance of intravascular volume and cardiac output to assure adequate oxygen delivery to donor tissue; re suscitation of the patient from spontaneous cardiac ar rest ; evaluation and reversal of polyuria; management of poikilothermia and the effects of hypothermia; and treat ment of hypopituitarism and other possible changes in circulating hormones. Individual organ function and the interdependency among donor organs must be carefully monitored and balanced to assure that the recipient re ceives organs that have the best opportunity for optimal primary function. Care of the multiorgan brain dead pa tient and his or her family requires a multidisciplinary team skilled not only in the medical and surgical aspects of transplantation but also in the care of families who have suffered loss.A new focus for patient care is appropriate after the decision has been made that a patient is brain dead and will become an organ donor. Because preser vation of brain function is no longer possible, treat ment priorities should shift to maximize perfusion and function of the donor organs. Through careful management of the donor patient, the recipient will receive organs that are less likely to undergo pri mary failure. This discussion will review the physio logical support necessary to sustain brain dead pa tients and to optimize donor organ function until organ removal is completed. It is assumed that indi vidual organs will be assessed and accepted or re jected for donation using criteria established by lo cal organ procurement teams. Such criteria will not be discussed here.The brain dead organ donor presents a variety of management challenges (Table 1) that may extend over many hours while members of transplant teams and organ recipients are assembled and tis sue testing is completed. The responsibility for care may remain with the admitting physician or critical care medicine specialists, or it may be transferred to the transplant service. Coordination, however, remains the key to a successful outcome. The avail ability and interest of a knowledgeable physician to supervise the donor patient's care continues to be crucial because a variety of problems, each capable of rendering donor organs useless, may develop in the hours between brain death and organ removal.Journal of Intensive Care Medicine 03/1989; 4(2):75-83. DOI:10.1177/088506668900400205