ICU Management of the Potential Organ Donor: State of the Art

Abstract

End-organ failure is associated with high mortality and morbidity, in addition to increased health care costs. Organ transplantation is the only definitive treatment that can improve survival and quality of life in such patients; however, due to the persistent mismatch between organ supply and demand, waiting lists continue to grow across the world. Careful intensive care management of the potential organ donor with goal-directed therapy has the potential to optimize organ function and improve donation yield.

Indicadores clínicos para o diagnóstico de enfermagem Síndrome do equilíbrio fisiológico prejudicado para doadores de órgãos

“…While respiratory alkalosis is commonly due to hyperventilation and diuretic treatment administered in an attempt to decrease intracranial pressure. [12][13][14] The literature shows that among the physiological changes resulting from brain death in the potential organ donor, diabetes insipidus occurs in 46 to 78% of the cases. 15,16 Diabetes insipidus without intervention causes polyuria and leads to hypernatremia and hypovolemic shock.…”

“…15 and also contribute to the viability of the organs offered for transplantation. 12,13 Gluconeogenesis increases with the "sympathetic storm" caused by brain death due to greater insulin resistance in peripheral tissues and reduced pancreas insulin secretion, causing hyperglycemia. The brain death also causes damage to the pituitary gland which can lead to hormonal deficiencies and also affects the central thermoregulation, and may result both in hypothermia as well as hyperthermia.…”

Evaluation of Organ Donation Rates Among in Patients with Anticipated Imminent Brain Death

“…Further, patients with brain death had significantly lower APACHE II scores at the time of ICU admission [median 18 (10-36)] compared to patients who died without BD [median 19 (8-32)] (p=0.011). However, there were no significant differences between patients with and without BD regarding SOFA scores assessed 24 hours after ICU admission [9 (4-17) vs. 9 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), respectively] (p=0.238). The time between ICU admission and the time the GCS score decreased to 3 was 16 (0-336) hours in the group that consented for organ donation and 24 (0-192) hours in the group that did not consent for organ donation; this difference was not significant (p=0.547).…”

“…For those patients whose families did not consent for organ donation, the time until cardiac arrest was a median of 6 (1-16) hours. For those patients whose families did consent for organ donation, the time until organ retrieval was a median of 7 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) hours.…”

“…(4) The ICU team responsible for patient treatment also plays an important role in the diagnosis of brain death, and is responsible for caring for potential organ donors, monitoring the effective use of ICU beds, and the termination of treatment in a timely manner. (5,6) Because potential organ donors need to undergo organ-saving treatments as soon as possible, the ICU care team should be effective and timely when making a diagnosis of brain death. (7) There are a limited number of studies related to the follow-up of comatose patients in association with brain death and the organ donation process.…”