Organ Dysfunction and Failure Following Brain Death Do Not Preclude Successful Donation

Essien, Eno-Obong; Parimi, Nehu; Gutwald-Miller, Jennifer; Nutter, Tyree; Scalea, Thomas M.; Stein, Deborah M.

doi:10.1007/s00268-017-4089-1

Cited by 9 publications

(9 citation statements)

References 30 publications

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“…1 f). This assumption was derived from the knowledge that in a brain dead patient, a neurohormonal catastrophic cascade, as well as haemodynamic and endocrine dysfunction, will ultimately lead to organ failure, brain liquification and subsequent cardiac arrest, in a short interval following BD 34 . Since, in the 3 patients mentioned above, true negative results for ancillary tests could not be verified, we excluded these patients from the statistical analysis of BD confirmation, thus despite the indirect evidence of non-BD, the “specificity” of CTA or DSA, when compared to clinical tests, could not be estimated.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography angiography scoring systems and the role of skull defects in the confirmation of brain death

Zampakis

Panagiotopoulos

Kalogeropoulou

et al. 2021

Sci Rep

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To assess and compare all current computed tomography angiography (CTA) scoring systems for the diagnostic workup of brain death (BD) to digital subtraction angiography (DSA) and clinical tests. Fifty-two patients with a clinical suspicion of BD underwent CTA and subsequently DSA. The diagnostic performance of all current CTA scoring systems was compared to that of DSA, in all patients with a suspicion of BD. A comparison to clinical tests was made only in DSA-positive for BD patients (n = 49), since in DSA-negative BD patients (n = 3) clinical tests were not performed. Further subgroup analysis was performed in relation to skull defects (SDs) stratification. Statistical analysis was conducted by applying statistics-contingency tables, Cochran’s-Q test and McNemar’s test. The CTA -10, and -7- and all 4-point scoring systems, showed overall sensitivities of 81,6%, 87.8% and 95.9% respectively and 100% specificity, when compared to DSA. In patients with a clinical verification of BD, the CTA -10 and -7-point scoring systems were significantly inferior to clinical tests (p = 0.004 and p = 0.031), while the 4-point scoring systems showed no such difference (p = 0.5). All 4-point scoring systems showed 100% sensitivity in patients with a minor SD or no SD. In patients with a major SD, all CTA scoring systems (− 10, − 7- and all 4-point) were less sensitive (62.5%, 62.5% and 75% respectively). The presence of a major SD was associated with an 8 × relative risk for false negative results in all 4-point scoring systems. CTA showed excellent diagnostic performance in patients with a suspicion of BD. The 4-point CTA scoring systems are the most sensitive for the diagnosis of BD, although in patients with a major SD patient, the role of CTA is ambiguous.

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Section: Discussionmentioning

confidence: 99%

Computed tomography angiography scoring systems and the role of skull defects in the confirmation of brain death

Zampakis

Panagiotopoulos

Kalogeropoulou

et al. 2021

Sci Rep

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“…While a number of studies have been conducted in solid organ transplantation (30)(31)(32)(33)(34), to date no studies have investigated brain death experimentally in the context of vascularized composite allografts. Here we demonstrate for the first time that the vasculature of vascularized composite allografts from brain dead donors have a significantly higher level of deposited complement activation products compared to vascularized composite allografts from living donor controls.…”

Section: Discussionmentioning

confidence: 99%

In Situ Pre-Treatment of Vascularized Composite Allografts With a Targeted Complement Inhibitor Protects Against Brain Death and Ischemia Reperfusion Induced Injuries

et al. 2021

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IntroductionDonor brain death (BD) is an unavoidable component of vascularized composite allograft (VCA) transplantation and a key contributor to ischemia-reperfusion injury (IRI). Complement is activated and deposited within solid organ grafts as a consequence of BD and has been shown to exacerbate IRI, although the role of BD and complement in VCA and the role it plays in IRI and VCA rejection has not been studied.MethodsBD was induced in Balb/c donors, and the VCA perfused prior to graft procurement with UW solution supplemented with or without CR2-Crry, a C3 convertase complement inhibitor that binds at sites of complement activation, such as that induced on the endothelium by induction of BD. Following perfusion, donor VCAs were cold stored for 6 hours before transplantation into C57BL/6 recipients. Donor VCAs from living donors (LD) were also procured and stored. Analyses included CR2-Crry graft binding, complement activation, toxicity, injury/inflammation, graft gene expression and survival.ResultsCompared to LD VCAs, BD donor VCAs had exacerbated IRI and rejected earlier. Following pretransplant in-situ perfusion of the donor graft, CR2-Crry bound within the graft and was retained post-transplantation. CR2-Crry treatment significantly reduced complement deposition, inflammation and IRI as compared to vehicle-treated BD donors. Treatment of BD donor VCAs with CR2-Crry led to an injury profile not dissimilar to that seen in recipients of LD VCAs.ConclusionPre-coating a VCA with CR2-Crry in a clinically relevant treatment paradigm provides localized, and therefore minimally immunosuppressive, protection from the complement-mediated effects of BD induced exacerbated IRI.

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“…The spectrum of systemic clinical sequelae of brain death ranges from minimal to severe dysautonomia and inflammatory responses. ICU management should be organized around the principles included below, with targeted strategies to stabilize hemodynamics and improve severe electrolyte derangements, thereby optimizing the viability and function of potential donor organs . In addition, cardiac‐specific evaluation of the deceased potential donor during this period facilitates transplant center decision‐making for donor heart selection and matching to potential recipients …”

Section: General Considerationsmentioning

confidence: 99%

Pediatric donor management to optimize donor heart utilization

Zimpfer¹,

Alexander

Davies

et al. 2020

Pediatric Transplantation

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Optimal management of pediatric cardiac donors is essential in order to maximize donor heart utilization and minimize the rate of discarded organs. This review was performed after a systematic literature review and gives a detailed overview on current practices and guidelines. The review focuses on optimal monitoring of pediatric donors, donor workup, hormonal replacement, and obliterating the adverse effects of brain death. The current evidence on catecholamine support and thyroid hormone replacement is also discussed. Recognizing and addressing this shall help in a standardized approach toward donor management and optimal utilization of pediatric heart donors organs. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Organ Dysfunction and Failure Following Brain Death Do Not Preclude Successful Donation

Abstract: Current measures of organ failure and dysfunction do not predict the success of organ donation. Successful donor management in the face of severe organ dysfunction and failure can result in lives saved.

Cited by 9 publications

References 30 publications

Computed tomography angiography scoring systems and the role of skull defects in the confirmation of brain death

Computed tomography angiography scoring systems and the role of skull defects in the confirmation of brain death

In Situ Pre-Treatment of Vascularized Composite Allografts With a Targeted Complement Inhibitor Protects Against Brain Death and Ischemia Reperfusion Induced Injuries

Pediatric donor management to optimize donor heart utilization

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