Evidence of Functional Myocardial Ischemia Associated With Myocardial Dysfunction in Brain-Dead Pigs

Endothelial activation through brain death?

“…1 Furthermore, it was clearly shown that the myocardium experiences ischemia early after brain death, owing to increased metabolic demand by the hyperdynamic situation, and insufficient increase in oxygen supply by relatively defective coronary vasodilatation. 7,8 In feline donor hearts, energetic failure was described during storage. 11 Apart from these deleterious ischemic conditions, other pathogenetic mechanisms likely contribute to donor heart dysfunction, such as pituitary dysfunction 12 and the uncoupling of ␤-receptors from the adenylyl cyclase, probably by alterations in G-protein transduction.…”

“…6 The exact pathophysiologic link between the event of "brain death" and the myocardial damage is still unknown. Increased interstitial adenosine and lactate, associated with myocardial dysfunction, 7,8 is further evidence of the ischemic cardiac status after brain death. In baboons, signs of coronary spasm with contraction bands were observed in coronary smooth muscle cells.…”

The Effects of Hormone Resuscitation on Cardiac Function and Hemodynamics in a Porcine Brain-Dead Organ Donor Model

“…The success of transplantation is critically dependant upon the quality of the donor organ, which is significantly influenced by the process of donor brain death (6)(7)(8)(9)(10)(11). Reported consequences of brain death include hemodynamic instability and donor organ dysfunction (7,9,10,12,13), rejection of organs for transplantation, and an overall increase in posttransplant complications (6,7,13,14).…”

“…Reported consequences of brain death include hemodynamic instability and donor organ dysfunction (7,9,10,12,13), rejection of organs for transplantation, and an overall increase in posttransplant complications (6,7,13,14). A characteristic feature of brain death is the 'sympathetic/autonomic storm' causing extreme hypertension and tachycardia, followed by loss of sympathetic tone and massive vasodilatation leading to hemodynamic instability (13).…”

“…A characteristic feature of brain death is the 'sympathetic/autonomic storm' causing extreme hypertension and tachycardia, followed by loss of sympathetic tone and massive vasodilatation leading to hemodynamic instability (13). The substantial increase in endogenous catecholamines that accompanies the 'storm' (15) causes organ ischemia (7,10,13) and increases cardiomyocyte intracellular calcium, which in turn initiates a cascade of events leading to disturbed metabolism, cellular injury and death (7,10,11,16). There is also associated myocardial structural damage (17), impaired ATP production (13,18) and free radical-mediated damage (13).…”