A Single-Center Experience with an Intensivist-Led Brain-Dead Donor Management Program

Abstract

BackgroundThe aim of this study is to report our experience of brain-dead donor management by a dedicated intensivist who had wide experience in treatment of hemodynamically unstable patient and to suggest a role for intensivists in organ donation.Material/MethodsThe management of brain-dead donors was performed by experienced intensivists. The hospital medical records and data from the Korean Network of Organ Sharing from August 2013 to December 2016 were reviewed retrospectively.ResultsFifty-four brain death patients (3.2% of KONOS nationwide data) donated organs in our institution during 41 months. Dedicated intensivists managed deceased patients for the whole duration (2.81±1.21 days) of management, not only with conservative therapies like fluid resuscitation, vasopressor, or hormonal replacement, but also with pulmonary artery catheter insertion for cardiac output monitoring (n=47, 87.0%) and continuous renal replacement therapy (n=22, 40.7%). The number of donors increased each year. The mean number of retrieved organs in each deceased donor was 3.98±1.55, more than the national average (3.26) and comparable to the higher level among the recent worldwide data. The number of donations by organ was: 23 hearts (4.9% of nationwide data), 17 lungs (7.5% of nationwide data), 102 kidneys (3.3% of nationwide data), 47 livers (3.1% of nationwide data), 6 pancreases (2.9% of nationwide data), 1 pancreatic duct (11.1% of nationwide data), and 1 small intestine (12.5% of nationwide data).ConclusionsManagement by dedicated intensivists will improve not only the number of actual organ donors, but also the number of harvested organs.

A stroke volume‐based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain‐dead donors

“…Frequently the donor also has a stunned myocardium with a decreased ejection fraction which complicates volume resuscitation . Some authors recommend aggressive fluid resuscitation prior to vasopressor use, whereas other authors recommend a restrictive fluid policy to increase lung donation …”

“…42 Some authors recommend aggressive fluid resuscitation prior to vasopressor use, whereas other authors recommend a restrictive fluid policy to increase lung donation. 2,8,[42][43][44] Published donor management guidelines have recommended a target CVP between 4 and 10 cm H 2 O to help manage fluid resuscitation. 18,39 Static measurements of hemodynamic performance, such as the CVP, have been shown to be unreliable in optimizing cardiac performance, and no better than a flip of the coin.…”

The Incidence of Brain-Dead Donors Based on Screening and Management Led by Intensivists

“…Several efforts have been made to improve identification of PBD donors and the acceleration of actual organ donation in the ICU. In a single-center study, dedicated intensivists in critical care management contributed to many organ donors [ 14 ]. Moreover, several single-center studies have documented that a dedicated intensivist could improve the quality of organ condition and increase the number of obtained organs, including the heart and lung, from a BD donor [ 14 , 15 ].…”

Evaluation of organ donation process and affecting factors in COVID-19 pandemic

“…Early detection of potential donors, successful organ donation from families, and correct management of these donors are issues that need to be emphasized. Poor care of potential donors, prolonged family approval and donation process may lead to organ loss [4,5].…”