Donation after Cardiac Death in Non-Survivable Burns

Widdicombe, Neil; Poll, Andrew van der; Gould, Andree; Isbel, N.

doi:10.1177/0310057x1304100317

Cited by 4 publications

(6 citation statements)

References 22 publications

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“…Widdicombe et al reported two successful cases of organ donation and transplantation after Maastricht category III cardiac death, in adult patients with non-survivable burn injuries. Good outcomes were achieved for both cases [2]. DCD in burn injured patients raises medical challenges related to the potential risks of splanchnic ischemic injury following burn shock, together with a high risk of bacterial contamination and sepsis [2–6].…”

Section: Discussionmentioning

confidence: 99%

“…In the past, the risk of ischemic organ injury, caused by burn shocks, was the rationale for considering major burns as a contraindication to organ donation. With acute intensive care progresses and innovations, this contraindication has lost absoluteness [2, 6]. As a matter of fact, the reported organ survival rates for major burned donors reached 86% [5] and the long-term outcomes are good too [4] (3).…”

Section: Discussionmentioning

confidence: 99%

“…However, there is no published literature advising on early resuscitation in patients with non-survivable burns to facilitate organ donation, including fluid formulae and fluid type, use of adjuncts such as inotropes, optimal monitoring, and clinical endpoints. Moreover, there are no clinical nor laboratory indices able to determine a donor’s suitability in burns [2]. Furthermore, no clear indications are given about an optimal timeframe to retrieve organs from fatal burns donors, in order to reduce the development of severe systemic inflammatory response syndrome [2].…”

Section: Discussionmentioning

confidence: 99%

“…It poses ethical challenges to include patients with fatal non-neurological conditions within the potential donor pool, especially in the context of end-of-life care, and medical problems. The challenges are set by severity of hypoperfusion and ischemic organ injury, as these two remain the dominant factors in influencing graft outcomes in these patients [2]. The proportion of DCD has increased in both trauma and non-trauma donors from less than 5% in 2000 to over 15% in 2016 [1].…”

Section: Introductionmentioning

confidence: 99%

“…Major burns have traditionally been considered a contraindication to organ donation. This is due to possible risks of splanchnic ischemic injury after burn shock, together with high risks of bacterial contamination and sepsis in burnt patients [2–6].…”

Section: Introductionmentioning

confidence: 99%

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At the heart of organ donation. Case reports of organ donation after cardiac death in two patients with successfully repaired AAST grade V cardiac injuries

et al. 2019

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BackgroundTrauma victims could be an important source of organs. This article presents two cases of successful organ donation and transplant, after Maastricht category III cardiac death in patients with successfully repaired AAST grade V traumatic cardiac injuries.Case presentationThe first donor was an adult patient with self-inflicted heart stab wound and non-survivable burn injury. The second one was an adult patient with blunt cardiac and abdominal trauma and an anoxic brain injury due to a car accident. The cardiac injury was promptly repaired in both patients. In the first case, adequate organ perfusion ante-mortem was achieved thanks to venoarterial extracorporeal membrane oxygenation and intensive care unit support. The above procedure allowed successful organ donation and transplantation even after Maastricht category III cardiac death. This is the first case reported where, for organ donation purposes, it was made necessary first thing to avoid the immediate death of the patient, due to a rare and frequently not survivable cardiac injury. The challenge of preserving organ perfusion, due to major burn injury effects, was faced afterwards.ConclusionsThe outcomes of these two cases suggest that a repaired heart injury should not be considered as an absolute contraindication to organ donation, even if it is associated with non-survivable major burns. Therefore, cardiac death could provide an opportunity for these kinds of patients to contribute to the pool of potential organ donors.

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Section: Discussionmentioning

confidence: 99%