Donación tras la muerte cardíaca. Parada cardíaca en el mantenimiento del donante en muerte encefálica

Abstract

Brain death implies the complete cessation of activity in both cerebral hemispheres and in the brainstem; this leads to severe physiopathological disorders that make donor maintenance complex and involve the concomitant risk of rapid organ deterioration. The heart is one of the target organs in this process of multiple organ failure. Myocardial stunning occurs due to a "catecholamine storm" and subsequent release of many proinflammatory mediators, free oxygen radicals, and electrolyte imbalance secondary to insipid diabetes and hypothermia. Cardiac arrest during the maintenance of a donor after brain death is relatively frequent. The shortage of organs for transplantation has led to the broadening of the criteria for organ donation to include donation after cardiac death or non heart beating donation, among others.

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: parte I. Aspectos gerais e suporte hemodinâmico

“…(88,89) In cases of brain death, bradyarrhythmias may be resistant to atropine, due to the lack of vagal activity; therefore, we recommend using adrenaline, dopamine or isoproterenol (D). (18,90,91) When persistent and associated with hypotension or low output, bradyarrhythmias should be treated with a transvenous pacemaker (D). (90) Previous family consent should be granted for all procedures required either for maintenance or removal of organs.…”

“…A number of authors suggest that the families should be also informed when cardiorespiratory resuscitation may be required and the relevant consent obtained (C). (91) Recommendations -Prevent and treat heart arrhythmias by correcting reversible causes, e.g., electrolyte and acid-base disorders, hypovolemia, hypotension, hypothermia, excessive/ inappropriate administration of catecholamines (D). (26) Strong Recommendation.…”

“…(18,90,91) -Treat bradyarrhythmias (without hemodynamic instability) using adrenaline (2-10 μg/min), dopamine (50-10 μg/kg/min) or isoproterenol (2-10 μg/kg/min) (D). (18,90,91) Strong Recommendation. -Treat bradyarrhythmias (with low output or hypotension) with a provisional transcutaneous pacemaker followed by tranvenous pacing (D).…”

“…(91,92) Recommendation -Give 500 IU/kg sodium heparin early during CPR maneuvers when immediate removal and/or perfusion is being considered (D). (91,92) Strong Recommendation.…”

Programmes for Uncontrolled donation after Circulatory Death: Clinical, Ethical and Legal Benchmarks

“…On one hand, these protocols potentially increase organ donation rates by making potential donors certain individuals who suffer an out-of-hospital cardiac arrest (OHCA). On the other hand, they raise a number of ethical concerns regarding on several points that has been identified by scholars and emergency health care providers: [1] lack of truthfulness and transparency on the information approach to the next of kin of potential donors, and [2] the possibility that organ donation could compromise treatment delivered to, at least, some patients profile. According to the best and updated evidence knowledge available on resuscitation techniques and options of care, high-quality ongoing resuscitation could be provided before to judge as futile the resuscitation attempts.…”