Guidelines for the assessment and acceptance of potential brain-dead organ donors

Abstract

Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.

Efetividade do processo de doação de órgãos para transplantes

“…(3) Several professionals participate in the donation process, especially those working in Intensive Care Units (ICUs) and emergency departments, who are responsible for identifying potential organ and tissue donors, diagnosing brain-death (BD), notifying the responsible institutions and communicating the diagnosis to family members. (4) In Brazil, current legislation determines that the family is responsible for the decision of organ donation after death. Thus, once the diagnosis of BD has been concluded and the contraindications for donation are discarded, the family is requested to confirm the diagnosis and the Intra-Hospital Organ and Tissue Donation for Transplant Commission (CIHDOTT) offers the possibility of the donation.…”

Cultura de segurança no processo de doação de órgãos: revisão de literatura

“…(6,8,25) Although practically all the studies were categorized as level IV evidence, relevant information was obtained, especially regarding the participation of the multiprofessional team, as well as the cohesion of these professionals in the thorough evaluation of the potential donor, in order to obtain quality organs and tissues, avoiding the transmission of infectious diseases or neoplasias to the transplant recipient. (7,15) Conducting an in-depth physical examination for potential donors was rated as effective in reducing risks and adverse events in transplants. (13)(14)(15) In addition, evidence from these studies indicates the use of tools (protocols, guidelines and directives) by the health team is important for safety in the donation and transplantation process, to investigate possible changes presented by the donor as well as by the transplant recipient.…”

“…All the stages are vital to the success of donation and transplant, and it is fundamental to establish a strong safety culture. (6)(7)(8) Considering the increasing number of potential and eff ective donors in Brazil in the last seven years (1,898 eff ective donors in 2010; 3,415 effective donors in 2017), in addition to the annual loss of potential donors, (over 4,000 due to cardiac arrest, family refusal, donation process logistics, and other indefi nite causes), it is fundamental, relevant, and necessary to understand the safety culture reality among the teams involved in these processes. (9) Likewise, for eff ective assistance in the organ donation and transplant process, professionals must consolidate their knowledge and attitudes on safety culture, with interconnection of this issue at each stage of the process.…”

Gene expression in the twilight of death

“…Organs for solid organ transplantation are mostly procured from brain dead donors [9]. By definition, "brain dead" means that the donor has irreversible loss of brain functions [10]. Organs procured from these donors are regarded as suboptimal in terms of quality because brain death causes a massive inflammatory response that triggers substantial circulatory, hormonal, and metabolic changes in the donor's body [11,12].…”