Functional Improvement Between Brain Death Declaration and Organ Harvesting

Grigoraş, Ioana; Blaj, Mihaela; Chelarescu, O.; Craus, C.; Florin, G.

doi:10.1016/j.transproceed.2009.12.007

Cited by 10 publications

(9 citation statements)

References 12 publications

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“…The latter was established to optimize the sensitivity and specificity of this confirmatory test but did not take into account ''guiding'' tests such as TCD and BIS. Such time saving could shorten the period before harvesting organs and thus affect graft quality [24].…”

Section: Discussionmentioning

confidence: 99%

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Confirmation of brain death diagnosis: A study on French practice

Orban

Ferret

Jambou

et al. 2015

Anaesthesia Critical Care & Pain Medicine

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Section: Discussionmentioning

confidence: 99%

“…Twenty percent of other ICUs followed a protocol [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The combination of these two reasons was chosen by 35% of respondents.…”

Section: Availability Of Conϐirmatory Tests (%)mentioning

confidence: 99%

Confirmation of brain death diagnosis: A study on French practice

Orban

Ferret

Jambou

et al. 2015

Anaesthesia Critical Care & Pain Medicine

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“…Adverse events include cardiac arrhythmias, metabolic acidosis, hypo tension, and diabetes insipidus. [24][25][26][27][28][29] In acidosis, the cardiovascular system has a decreased respon siveness to catecholamines that causes a decrease in blood and dilation of the blood vessels. Mechanical ventilators can provide oxygen and remove carbon dioxide.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Zhang

Cao²,

Wang³

et al. 2014

Exp Clin Transplant

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Objectives: Experimental animal models of brain death that mimic human conditions may be useful for investigating novel strategies that increase quality and quantity of organs for transplant. Materials and Methods: Brain death was induced by increasing intracranial pressure by inflating an intracranial placed balloon catheter. Brain death was confirmed by flatline electroencephalogram, physical signs of apnea, and absence of brain stem reflexes. Donor management was done after brain death. Intracranial pressure and physiologic variables were continually monitored during 9 hours' follow-up. Results: Ninety percent of brain dead animals showed typical signs of brain death such as diabetes insipidus, hypertensive, and hypotensive periods. Donor care was performed for 9 hours after brain death, and the mean arterial pressure was maintained above 60 mm Hg. Conclusions: We conclude that the rat model of brain death can be performed in a standardized, reproducible, and successful way.

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“…The detection of reversible dysfunctional myocardium is clinically relevant, as regional or global left ventricular function will improve after transplant [14,15]. Such recovery can be facilitated, elicited by cardiovascular targeted intensive treatment, including hormonal treatment and noradrenaline sparing strategy, lasting until 24–48 h before harvesting [8-10,16,17]. Thus, the challenge is to identify markers that indicate which hearts are likely to have good function or be treated to satisfactory hemodynamic status and transplantation suitability.…”

Section: Discussionmentioning

confidence: 99%

Wait, treat and see: echocardiographic monitoring of brain-dead potential donors with stunned heart

Casartelli

Bombardini

Simion

et al. 2012

Cardiovasc Ultrasound

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BackgroundHeart transplantation is limited by a severe donor organ shortage. Potential donors with brain death (BD) and left ventricular dysfunction due to neurogenic stunning are currently excluded from donation – although such abnormalities can be reversible with aggressive treatment including Hormonal Treatment (HT) and deferred organ retrieval.AimTo assess the recovery of left ventricular dysfunction in potential brain-dead donors with hemodynamic instability treated by aggressive treatment and HT.MethodsIn a single-center, observational study design, we evaluated 15 consecutive brain-dead potential donors (DBD) (8 males, age = 48 ± 15 years) with hemodynamic instability. All underwent standard hemodynamic monitoring and transthoracic 2-dimensional echo (2-DE) with assessment of Ejection Fraction (EF). Measurements were obtained before BD and after BD within 6 h, at 24 h and within 48 h. HT (with insulin, methylprednisolone, vasopressin and T3) was started as soon as possible to treat hemodynamic instability and avoid administration of norepinephrine (NE). Eligible potential heart donors underwent coronary angiography.ResultsAfter HT, we observed a normalization of hemodynamic conditions with improvement of mean arterial pressure (pre = 68 ± 8 mmHg vs post = 83 ± 13 mmHg, p < .01), cardiac index (pre = 2.4 ± 0.6 L/min/m2 vs post 3.7 ± 1.2 L/min/m2, p < .05), EF (pre = 48 ± 15 vs post = 59 ± 3%, p < .01) without administration of norepinephrine (NE) in 67% of cases. Five potential donors were excluded from donation (opposition, n = 3, tubercolosis n = 1, malignancy n = 1). At pre-harvesting angiography, coronary artery stenosis was present in 2 of the 10 consented donors. Eight hearts were uneventfully transplanted. No early graft failure occurred and all eight recipients were alive at 6-month follow-up.ConclusionIn BD donors, intensive treatment including HT is associated with improvement of regional and global LV function and reverse remodeling detectable by transthoracic 2DE. Donor hearts with recovered LV function may be eligible for uneventful heart transplant. The wait (in brain death), treat (with HT) and see (with 2D echo) strategy can help rescue organs suitable for heart donation.

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Functional Improvement Between Brain Death Declaration and Organ Harvesting

Cited by 10 publications

References 12 publications

Confirmation of brain death diagnosis: A study on French practice

Confirmation of brain death diagnosis: A study on French practice

Untitled

Wait, treat and see: echocardiographic monitoring of brain-dead potential donors with stunned heart

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