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

Abstract

Brain death (BD) alters the pathophysiology of patients and may damage the kidneys, the lungs, the heart and the liver. To obtain better quality transplant organs, intensive care physicians in charge of the maintenance of deceased donors should attentively monitor these organs. Careful hemodynamic, ventilatory and bronchial clearance management minimizes the loss of kidneys and lungs. The evaluation of cardiac function and morphology supports the transplant viability assessment of the heart. The monitoring of liver function, the management of the patient's metabolic status and the evaluation of viral serology are fundamental for organ selection by the transplant teams and for the care of the transplant recipient. OBJECTIVEThese guidelines are aimed at contributing to the institutional coordination of organ transplantation and will provide "real world" guidelines that are appropriate in the Brazilian context for the uniform care of the deceased donor. Ultimately, this aim of this guide is to increase the quality and quantity of transplantable organs. METHODOLOGYThe Writing and Planning Committee, comprised of young intensive care physicians and intensive medicine residents, conducted an extensive literature review. From this review, they formulated questions and forwarded the questions to all of the authors of this article. These initial questions served as the starting point for receiving suggestions for the formulation of other questions and definitions.The final questions were revised by the Executive Committee and were returned to the authors to develop the guidelines presented in this article.The questions guided the literature review, which was conducted using the P.I.C.O. methodology where P stands for the target population, I for the intervention, C for the control or comparative group and O for the clinical outcome.The retrieved articles were critically analyzed and categorized according to their grade of recommendation and the strength of the presented evidence in the following manner:

Process of Organ Donation and Tissue in Hospital Units

“…The data collection instrument was developed based on the fundamental recommended by the scientific literature [6][7][13][14][15][16], set up in a structured script non-participant observation, checklist type, composed of the following parts: personal identification data; data on the donation process related to the identification, notification, assessment and maintenance of PD, diagnosis of BD, family interview, documentation, logistics, information about the collection and results of the donation.…”

Morte encefálica e manutenção de órgãos: conhecimento dos profissionais intensivistas

“…In this way, it is necessary to have adequate knowledge on the part of the professionals to provide effective assistance to these patients. 10 The ideal temperature, to be maintained in the potential donor patient, is between 36 and 37.5º C, that is, the same parameter considered ideal of central temperature in the other individuals, with the proviso that it is higher than 35º C, thus, considering a limit of temperature between 35 and 37.5 ° C. 8 In the potential donor, greater care should be taken in this regard, since, in brain death there is loss of thermoregulatory function, resulting, in progressive hypothermia, tending to equalize body temperature at room temperature.…”

“…8,11 Encephalic death culminates in a series of autonomic, metabolic and hemodynamic disorders responsible for deterioration of cardiocirculatory stability and tissue perfusion that result in cardiac arrest. After the onset of brain death, cardiocirculatory function can be maintained through supportive measures, such as mechanical ventilation, vasoactive drugs and artificial heating, for variable times.…”

“…8 Absolute contraindications are the responsibility of the hospital coordinator or the Organ Procurement Organization or Center for Notification, Training and Distribution of Organs. The decision on the use of a particular organ or tissue belongs to the transplant team, which will carry out a case-specific evaluation.…”

“…Thus, the importance of the recognition of brain death, the adequate approach of the family and the clinical maintenance of the deceased donor by the professionals involved. 8 • To evaluate the knowledge of the health professionals who work in the Intensive Care Unit on the diagnosis of brain death and the maintenance of organs in potential donors.…”