Physiological changes after brain stem death and management of the heart-beating donor

The effect of brain death protocol duration on potential donor losses due to cardiac arrest

“…This time interval is similar to those reported by other publications that have shown an association between a BDPD of 12 and 24 hours with better renal graft function in the short and long terms . The high frequency of losses observed in the first 12 hours of protocol may be attributed to the greater impact of the initial sympathetic storm on the perfusion of various organs, to a greater severity of the disease that led to BD, and to not achieving essential management goals early enough . Losses that occur when the BDPD is >30 hours may be associated with an inflammatory peak that extends until the third day .…”

“…[19][20][21] The high frequency of losses observed in the first 12 hours of protocol may be attributed to the greater impact of the initial sympathetic storm on the perfusion of various organs, to a greater severity of the disease that led to BD, and to not achieving essential management goals early enough. 1,6,12 Losses that occur when the BDPD is >30 hours may be associated with an inflammatory peak that extends until the third day. 21 Thus, the use of an approximate chronological target of 12-24 hours for the procurement of organs 12,13 appears to be appropriate, not only for better graft function [19][20][21] but also because of the prevention of donor loss due to cardiac arrest.…”

“…Organ donation from deceased donors with brain death (BD) is the main source of transplant organs. However, with reductions in hospital mortality and in the proportion of patients with brain injury progressing to BD, post‐BD donations have also decreased, increasing the disparity between the demand for transplant organs and the number of effective transplants . Thus, from the perspective of a public health problem, simultaneous actions that promote early recognition of BD, an appropriate approach on the part of the family, and adequate clinical management of the deceased donor are essential to mitigate this disparity.…”

“…However, with reductions in hospital mortality and in the proportion of patients with brain injury progressing to BD, post-BD donations have also decreased, increasing the disparity between the demand for transplant organs and the number of effective transplants. 1,2 Thus, from the perspective of a public health problem, simultaneous actions that promote early recognition of BD, an appropriate approach on the part of the family, and adequate clinical management of the deceased donor are essential to mitigate this disparity. In this context, it is known that aggressive clinical management of the potential donor using goaloriented protocols is associated with a greater number of organs transplanted per donor and the reduction in losses of potential donors due to cardiac arrest.…”

Care of the Brain-Dead Organ Donor

“…Despite this, international guidelines recommend esmolol or sodium nitroprusside infusions as first-line agents to be started if MAP remains > 90 mm Hg or SBP remains ≥ 160/90 mm Hg. 35,47 Management Post-Catecholamine Storm…”