Management of Neuroendocrine Instability During Maintenance of Potential Organ Donors

Donor Assessment and Management for Heart Transplantation

“…Many investigators [3,4] have reported that a short-lived catecholamine (CA) storm derived from acute intracranial hypertension caused systemic hypertension, acute left ventricular (LV) failure, and acute transient mitral valve regurgitation, leading to a rise in left atrial pressure in animal experiments. These events led to ischemic myocardial damage of LV associated with pulmonary edema.…”

“…After BD, the brain-heart connections are definitively interrupted and autonomic cardiovascular regulation mainly thorough baroreflex is gone. Therefore, the hemodynamics of BD persons become unstable [4]. For example, a decrease in the blood return to the heart due to blood loss, hypovolemia, and putting pressure on the upper abdomen or postural change may rapidly cause low blood pressure in BD persons.…”

“…The most troublesome issue facing HTx is primary allograft dysfunction (PGD) [3,4]. This complication is the leading cause of early post-HTx death in the world.…”

“…However, if a transplant recipient dies soon after HTx due to PGD, the donor family feels the loss of their lover again. Therefore, donor management strategies to improve heart graft function and reduce early post-HTx mortality are very important for the donor family as well as for recipients [2][3][4].…”

“…Full-scale donor management begins after the potential donor is sentenced brain dead and his or her family's consent to organ donation is obtained [2][3][4]. Basic therapeutic strategies for donor management consist of interventions for impaired heart and lung function to optimize the patient's hemodynamics, increase oxygen delivery to peripheral tissue, and finally improve the function of other organs, such as the liver and kidney.…”