Aggressive Organ Donor Management Protocol

Abstract

As of August 2007, 96 900 people are awaiting organ transplantation in the United States, while only 28 930 transplants were performed in 2006. With such a large gap between organ need and organ availability, it is inevitable that many will die while awaiting transplantation. This organ shortage has become a national public health crisis, and as a response, the United States Department of Health and Human Services launched the Organ Donation Breakthrough Collaborative, an ambitious campaign to dramatically increase the number of transplantable organs. One of the suggested strategies involves maximizing the number of organs obtained from the available cadaveric "brain dead'' donor pool by using donor management protocols that optimize and treat the profound physiological disturbances that are associated with brain death. The use of these standardized and aggressive donor management protocols has been shown to increase the number of transplanted organs and prevent the number of donors lost due to medical failures. A protocol-driven approach by a dedicated organ donor management team should be considered a key component of any program designed to bridge the gap between organ supply and demand.

Human Dendritic Cell Subsets from Spleen and Blood Are Similar in Phenotype and Function but Modified by Donor Health Status

“…1D). However, the frequency of CD141 + cDC and the CD304 + pDC recovered from total splenocytes from cardiac death donors was markedly reduced, consistent with the recognized inferior quality of cardiac death tissues (30). Because of this, and because of the rarity of non-MP-treated donors, our focus was on DC from braindead organ donor spleens.…”

“…We used deceased organ donors in which life-support was maintained prior to brain death, resulting in optimal quality of the tissue (30). We developed new methods to isolate and functionally characterize DC subsets from spleen for a comprehensive comparison of all human spleen and blood DC subsets, and addressed organ donor-related effects on DC.…”

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: Parte III. Recomendações órgãos específicas

“…The respiratory management of a potential donor is frequently complicated by pulmonary injuries such as the following: neurogenic pulmonary edema, respiratory infections, pulmonary bleeding and traumatic pulmonary injury (D) (6,54,55) (C). (56) The development of atelectasis secondary to the supine position of the deceased donor, the prolonged period of mechanical ventilation and aggressive fluid resuscitation are frequent causes of hypoxemia.…”

Immediately Functioning Grafts from Brain-Dead Donors Treated with Extracorporeal Membrane Oxygenation

“…These potential donors need optimized therapeutic support to prevent donor loss and increase the number of viable retrieved organs. 1,2 Extracorporeal membranous oxygenation (ECMO) has been increasingly used as bridge therapy for patients with potentially reversible cardiac or respiratory failure. Normally, patients offered this form of treatment are deemed to have good overall organ status before experiencing acute cardiac or respiratory events.…”

“…However, a significant number of patients treated with ECMO do not recover because of either the nonsalvageable nature of their heart or respiratory condition or a neurologic event that sometimes accompanies this form of therapy. [1][2][3] There have been few reports about the outcomes of organs retrieved from patients after treatment with ECMO. Orandi and colleagues (2015) reported that, out of 82 143 deceased-donor kidney transplants, 22 185 (27.0%) recipients developed delayed graft function (DGF).…”