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.
- [show abstract] [hide abstract]
ABSTRACT: 1. To document the clinical course of paediatric beating heart organ donors. 2. To evaluate the effect of the ICU management of pediatric donors on the immediate function of transplanted organs. 3. To examine the validity of current donor selection criteria. Retrospective chart review and case series study. Multidisciplinary ICU of tertiary referral paediatric hospital. All patients who became solid organ donors between January 1980 and July 1990. 1. Incidence of major physiological abnormalities of the cardiovascular, pulmonary, renal and metabolic systems. 2. Number of organs retrieved and transplanted, reasons for non-transplantation of donated organs. 3. Immediate post-transplant function of transplanted organs. Seventy-seven organ donors were identified from whom 134 kidneys, 31 livers and 12 hearts were transplanted. Sixty (78%) patients developed diabetes insipidus. Sustained hypotension occurred in 41 (53.2%) and was commoner in patients treated with inotropic agents in the presence of a low central venous pressure and in patients with diabetes insipidus who did not receive anti-diuretic hormone replacement. Twenty-seven patients suffered at least one cardiac arrest. The data on post-transplant function were obtained for 129 kidneys (from 70 donors) 30 livers and 9 hearts. Fifty-two kidneys, 10 livers and 2 hearts were transplanted from donors who had suffered at least one cardiac arrest without apparent adverse effect on post-transplant organ function. Thirty-six kidneys from 31 donors suffered either acute tubular necrosis (ATN) or primary non-function. The donors of these organs spent longer in ICU (60.6 +/- 45.7 h versus 41.8 +/- 30.1 h p = 0.045) and had a higher mean maximum serum sodium concentration (163.4 +/- 10.9 versus 158.5 +/- 9.5 mmol/l p = 0.05) than those without these complications. The serum creatinine concentration and degree of inotropic support did not predict post-transplant function. Standard biochemical tests for hepatic function, the dose of inotropic agent received, time in ICU and incidence of hypotension did not predict post-transplant liver function. Aggressive fluid resuscitation and management of diabetes insipidus may promote stability in paediatric organ donors. Donor cardiac arrest does not alter the ICU course or compromise post-transplant organ function. The current criteria used for donor selection failed to predict post-transplant organ function and their use may increase organ wastage.Intensive Care Medicine 01/1997; 22(12):1424-32. · 5.26 Impact Factor
Article: Care of the multiple organ donor.[show abstract] [hide abstract]
ABSTRACT: Successful organ transplantation offers patients with end stage organ failure the chance of a normal life. The recognition of brain death allowed the use of beating heart donors and this has enabled multiple organ procurement from a single donor. Suitable patients with severe brain injury resulting in brain death, who may be potential organ donors, are to be found on both neurosurgical and general intensive care units. The pathophysiological results of brain death are similar, irrespective of the underlying cause. Severe brain injury may result in the loss of temperature regulation, and the development of diabetes insipidus and cardiovascular instability. The management of brain injury before death often results in abnormalities of fluid balance, due to fluid restriction and diuretic therapy. Other problems such as acute endocrine failure and the impact of their correction on ultimate organ function remains to be elucidated. Good donor maintenance in the intensive care unit and operating theatre is essential if optimal function of the transplanted organ is to occur.Intensive Care Medicine 02/1989; 15(6):340-8. · 5.26 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: 1. Until recently, when drugs were used in critically ill patients they were expected to behave in the same way as in less seriously ill patients. Now the unpredictability of even the most reliable drugs has been recognized. With this there is an awareness of the adverse effects drugs may have on organs other than the ones the drug was intended to act on. In patients with multiorgan dysfunction, poly-pharmacy is usually needed. The drugs may not only interfere with the action of each other at the receptor and enzyme level, but may also change protein binding and elimination. All these effects may be unimportant in less seriously ill patients, but may affect outcome in the critically ill. A high degree of awareness and suspicion of unknown drug-induced adverse reaction is needed by clinicians and pharmacologists alike.Xenobiotica 12/1993; 23(11):1195-230. · 1.98 Impact Factor