Worldwide management of donors after neurological death: a systematic review and narrative synthesis of guidelines

Frenette, Anne Julie; Weiss, Matthew J.; Rochwerg, Bram; Ball, Ian; Brindamour, Dave; Serri, Karim; D’Aragon, Frédérick; Meade, Maureen O.; Charbonney, Emmanuel

doi:10.1007/s12630-020-01815-0

Cited by 9 publications

(7 citation statements)

References 45 publications

(167 reference statements)

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“…In addition, cardiopulmonary resuscitation in the emergency department and multiple injuries seem to reduce OD in eligible TDs. According to the latest guidelines [17], all patients in our study underwent hormone replacement therapy. It appears that liver and kidney organ-specific injuries do not affect OD or outcomes of the transplanted organ.…”

Section: Discussionmentioning

confidence: 99%

Organ Donation after Damage Control Strategy in Trauma Patients: Experience from First Level Trauma Center in Italy

Altomare

Bekhor

Cioffi

et al. 2022

Life

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Background: Organ donation (OD) remains the only therapeutic option for end-stage disease in some cases. Unfortunately, the gap between donors and recipients is still substantial. Trauma patients represent a potential yet underestimated pool of organ donors. In this article, we present our data on OD after damage control strategy (DCS). Materials and Methods: A retrospective, observational cohort study was conducted through a complete revision of data of consecutive adult trauma patients (>18 years old) who underwent OD after DCS between January 2018 and May 2021. Four subgroups were created [Liver (Li), Lungs (Lu), Heart (H), Kidneys (K)] to compare variables between those who donated the organ of interest and those who did not. Results: Thirty-six patients underwent OD after DCS. Six patients (16.7%) were excluded: 2(5.6%) for missing data about admission; 4(11.1%) didn’t receive DCS. Mean ISS was 47.2 (SD ± 17.4). Number of donated organs was 113 with an organs/patient ratio of 3.8. The functional response rate was 91.2%. Ten organs (8.8%) had primary nonfunction after transplantation: 2/15 hearts (13.3%), 1/28 livers (3.6%), 4/53 kidneys (7.5%) and 3/5 pancreases (60%). No lung primary nonfunction were registered. Complete results of subgroup analysis are reported in supplementary materials. Conclusion: Organ donation should be considered a possible outcome in any trauma patient. Aggressive damage control strategy doesn’t affect the functional response rate of transplanted organs.

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Section: Discussionmentioning

confidence: 99%

Organ Donation after Damage Control Strategy in Trauma Patients: Experience from First Level Trauma Center in Italy

Altomare

Bekhor

Cioffi

et al. 2022

Life

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“…Still, they are limited by a lack of strong evidence and inconsistency between guidelines. 4 In the United States, 57 different organ procurement organizations (OPOs) identify deceased donors and coordinate organ recoveries in discrete regions. Many organizations use clinical protocols to assist clinicians caring for potential deceased donors.…”

Section: To the Editormentioning

confidence: 99%

Anesthetic Management of Organ Recovery Procedures: Opportunities to Increase Clinician Engagement and Disseminate Evidence-based Practice

Vail¹,

Chun

Tsai³

et al. 2023

Journal of Neurosurgical Anesthesiology

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“…The severity of circulatory changes have been related to the speed of brain death. More severe hemodynamic alterations were described when brain death develops in a shorter time[ 19 ].…”

Section: Hemodynamic Managementmentioning

confidence: 99%

Hemodynamic management in brain dead donors

Lazzeri¹,

Bonizzoli²,

Guetti³

et al. 2021

WJT

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Donor management is the key in the complex donation process, since up to 20% of organs of brain death donors (DBD) are lost due to hemodynamic instability. This challenge is made more difficult due to the lack of strong recommendations on therapies for hemodynamic management in DBDs and more importantly to the epidemiologic changes in these donors who are becoming older and with more comorbidities (marginal donors). In the present manuscript we aimed at summarizing the available evidence on therapeutic strategies for hemodynamic management (focusing on vasoactive drugs) and monitoring (therapeutic goals). Evidence on management in elderly DBDs is also summarized. Donor management continues critical care but with different and specific therapeutic goals since the number of donor goals met is related to the number of organs retrieved and transplanted. Careful monitoring of selected parameters (possibly including serial echocardiography) is the clinical tool able to guarantee the achievement and maintaining of therapeutic goals. Despide worldwide differences, norepinephrine is the vasoactive of choice in most countries but, whenever higher doses (> 0.2 mcg/kg/min) are needed, a second vasoactive drug (vasopressin) is advisable. Hormonal therapy (desmopressin, corticosteroid and thyroid hormone) are suggested in all DBDs independently of hemodynamic instability. In the single patient, therapeutic regimen (imprimis vasoactive drugs) should be chosen also according to the potential organs retrievable ( i.e. heart vs liver and kidneys).

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Worldwide management of donors after neurological death: a systematic review and narrative synthesis of guidelines

Cited by 9 publications

References 45 publications

Organ Donation after Damage Control Strategy in Trauma Patients: Experience from First Level Trauma Center in Italy

Organ Donation after Damage Control Strategy in Trauma Patients: Experience from First Level Trauma Center in Italy

Anesthetic Management of Organ Recovery Procedures: Opportunities to Increase Clinician Engagement and Disseminate Evidence-based Practice

Hemodynamic management in brain dead donors

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