Organ Donor Management: Part 1. Toward a Consensus to Guide Anesthesia Services During Donation After Brain Death

Abstract

Worldwide 715 482 patients have received a lifesaving organ transplant since 1988. During this time, there have been advances in donor management and in the perioperative care of the organ transplant recipient, resulting in marked improvements in long-term survival. Although the number of organs recovered has increased year after year, a greater demand has produced a critical organ shortage. The majority of organs are from deceased donors; however, some are not suitable for transplantation. Some of this loss is due to management of the donor. Improved donor care may increase the number of available organs and help close the existing gap in supply and demand. In order to address this concern, The Organ Donation and Transplantation Alliance, the Association of Organ Procurement Organizations, and the Transplant and Critical Care Committees of the American Society of Anesthesiologists have formulated evidence-based guidelines, which include a call for greater involvement and oversight by anesthesiologists and critical care specialists, as well as uniform reporting of data during organ procurement and recovery.

Intraoperative Management of Brain-dead Organ Donors by Anesthesiologists during an Organ Procurement Procedure: Results from a French survey

“…Our study aimed at describing current practices and perceptions of a large panel of anesthesiologists on the intraoperative management of BBD. The few existing recommendations on the subject are essentially based on expert opinions or extrapolated from ICU guidelines for brain dead donor management [1,2]. Briefly, our survey suggests that anesthetic practices concerning monitoring, DMGs, fluid resuscitation and ventilatory management are in agreement with current guidelines [4][5][6][7].…”

“…Brain-dead donors (BDD) currently remain the primary source of grafts for solid organ transplantation over the world [1,2]. In this context, appropriate management of organ donors from the diagnosis of brain death to the end of the organ procurement (OP) procedure is of paramount importance to ensure the functionality of potential grafts.…”

“…This is an active research field [3] and many guidelines are published and regularly updated over the last years [4][5][6][7]. Conversely, perioperative and anesthetic management of the donor during the OP procedure is far less codified [2,8]. French guidelines mainly specify to follow the same organ resuscitation strategy initiated in the ICU and only specify that the use of neuromuscular blocking (NMB) agents and analgesics are justified [5].…”

Intraoperative management of brain-dead organ donors by anesthesiologists during an organ procurement procedure: Results from a French survey

“…Our study aimed at describing current practices and perceptions of a large panel of anesthesiologists on the intraoperative management of BDD. The few existing recommendations on the subject are essentially based on expert opinions or extrapolated from ICU guidelines for BDD management [1,2].…”

“…This is an active research field [3] and many guidelines were published and regularly updated over the last years [4][5][6][7]. Conversely, intraoperative and anesthetic management of the donor during the OP procedure is far less codified [2,8]. French guidelines mainly specify to follow the same organ resuscitation strategy initiated in the ICU and only specify that the use of neuromuscular blocking (NMB) agents and analgesics are justified [5].…”