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11.02.2019 | Review

Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality

verfasst von: Geert Meyfroidt, Jan Gunst, Ignacio Martin-Loeches, Martin Smith, Chiara Robba, Fabio Silvio Taccone, Giuseppe Citerio

Erschienen in: Intensive Care Medicine | Ausgabe 3/2019

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Abstract

Purpose

To provide a practical overview of the management of the potential organ donor in the intensive care unit.

Methods

Seven areas of donor management were considered for this review: hemodynamic management; fluids and electrolytes; respiratory management; endocrine management; temperature management; anaemia and coagulation; infection management. For each subchapter, a narrative review was conducted.

Results and conclusions

Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. Temperature management of the donor is an area of uncertainty, but it appears reasonable to strive for a core temperature of > 35 °C. The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. Although the rate of infection transmission from donor to receptor is low, certain infections are still a formal contraindication to organ donation. However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.

Citerio G, Cypel M, Dobb GJ et al (2016) Organ donation in adults: a critical care perspective. Intensive Care Med 42:305–315PubMed

Tullius SG, Rabb H (2018) Improving the supply and quality of deceased-donor organs for transplantation. N Engl J Med 378:1920–1929PubMed

Van Loon J, Shivalkar B, Plets C et al (1993) Catecholamine response to a gradual increase of intracranial pressure. J Neurosurg 79:705–709PubMed

Smith M (2004) Physiologic changes during brain stem death—lessons for management of the organ donor. J Heart Lung Transplant 23:S217–S222PubMed

Novitzky D, Rhodin J, Cooper DKC et al (1997) Ultrastructure changes associated with brain death in the human donor heart. Transpl Int 10:24–32PubMed

Audibert G, Charpentier C, Seguin-Devaux C et al (2006) Improvement of donor myocardial function after treatment of autonomic storm during brain death. Transplantation 82:1031–1036PubMed

Drory Y, Ouaknine G, Kosary IZ, Kellermann JJ (1975) Electrocardiographic findings in brain death; description and presumed mechanism. Chest 67:425–432PubMed

Kotloff RM, Blosser S, Fulda GJ et al (2015) Management of the potential organ donor in the ICU: society of critical care medicine/American college of chest physicians/association of organ procurement organizations consensus statement. Crit Care Med 43:1291–1325PubMed

Lazzeri C, Guetti C, Migliaccio ML et al (2017) The utility of serial echocardiograms for organ procurement in brain death. Clin Transplant 31:e13094

10.

Dictus C, Vienenkoetter B, Esmaeilzadeh M et al (2009) Critical care management of potential organ donors: our current standard. Clin Transplant 23:2–9PubMed

11.

Al-Khafaji A, Elder M, Lebovitz DJ et al (2015) Protocolized fluid therapy in brain-dead donors: the multicenter randomized MOnIToR trial. Intensive Care Med 41:418–426PubMedPubMedCentral

12.

Stoica SC, Satchithananda DK, White PA et al (2004) Noradrenaline use in the human donor and relationship with load-independent right ventricular contractility. Transplantation 78:1193–1197PubMed

13.

Schnuelle P, Gottmann U, Hoeger S et al (2009) Effects of donor pretreatment with dopamine on graft function after kidney transplantation. JAMA 302:1067–1075PubMed

14.

Birtan D, Arslantas MK, Altun GT et al (2018) Effect of vasoactive therapy used for brain-dead donors on graft survival after kidney transplantation. Transplant Proc 50:1289–1291PubMed

15.

McKeown DW, Bonser RS, Kellum JA (2012) Management of the heartbeating brain-dead organ donor. Br J Anaesth 108:i96–i107PubMed

16.

Maciel CB, Greer DM (2016) ICU management of the potential organ donor: state of the art. Curr Neurol Neurosci Rep 16:86PubMed

17.

Perner A, Haase N, Guttormsen AB et al (2012) Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med 367:124–134PubMed

18.

Myburgh JA, Finfer S, Bellomo R et al (2012) Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 367:1901–1911PubMed

19.

Patel MS, Niemann CU, Sally MB et al (2015) The impact of hydroxyethyl starch use in deceased organ donors on the development of delayed graft function in kidney transplant recipients: a propensity-adjusted analysis. Am J Transplant 15:2152–2158PubMed

20.

Miñambres E, Ballesteros MA, Rodrigo E et al (2013) Aggressive lung donor management increases graft procurement without increasing renal graft loss after transplantation. Clin Transplant 27:52–59PubMed

21.

Youn TS, Greer DM (2014) Brain death and management of a potential organ donor in the intensive care unit. Crit Care Clin 30:813–831PubMed

22.

Tisdall M, Crocker M, Watkiss J, Smith M (2006) Disturbances of sodium in critically ill adult neurologic patients. J Neurosurg Anesthesiol 18:57–63PubMedPubMedCentral

23.

Plurad DS, Bricker S, Neville A et al (2012) Arginine vasopressin significantly increases the rate of successful organ procurement in potential donors. Am J Surg 204:856–861PubMed

24.

Busl KM, Bleck TP (2015) Neurogenic pulmonary edema. Crit Care Med 43:1710–1715PubMed

25.

López-Aguilar J, Villagrá A, Bernabé F et al (2005) Massive brain injury enhances lung damage in an isolated lung model of ventilator-induced lung injury*. Crit Care Med 33:1077–1083PubMed

26.

Mascia L, Sakr Y, Pasero D et al (2008) Extracranial complications in patients with acute brain injury: a post-hoc analysis of the SOAP study. Intensive Care Med 34:720–727PubMed

27.

MacLean A, Dunning J (1997) The retrieval of thoracic organs: donor assessment and management. Br Med Bull 53:829–843PubMed

28.

Wheeler AP, Bernard GR (2007) Acute lung injury and the acute respiratory distress syndrome: a clinical review. Lancet 369:1553–1564

29.

Krebs J, Tsagogiorgas C, Pelosi P et al (2014) Open lung approach with low tidal volume mechanical ventilation attenuates lung injury in rats with massive brain damage. Crit Care 18:R59PubMedPubMedCentral

30.

Mascia L, Pasero D, Slutsky AS et al (2010) Effect of a lung protective strategy for organ donors on eligibility and availability of lungs for transplantation. JAMA 304:2620PubMed

31.

ARDSNet (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301

32.

Slutsky AS, Ranieri VM (2013) Ventilator-induced lung injury. N Engl J Med 369:2126–2136PubMed

33.

Botha P (2009) Extended donor criteria in lung transplantation. Curr Opin Organ Transplant 14:206–210PubMed

34.

Mascia L, Bosma K, Pasero D et al (2006) Ventilatory and hemodynamic management of potential organ donors: an observational survey*. Crit Care Med 34(2):321–327PubMed

35.

Howlett TA, Keogh AM, Perry L et al (1989) Anterior and posterior pituitary function in brain-stem-dead donors. A possible role for hormonal replacement therapy. Transplantation 47:828–834PubMed

36.

Gramm HJ, Meinhold H, Bickel U et al (1992) Acute endocrine failure after brain death? Transplantation 54:851–857PubMed

37.

Novitzky D, Mi Z, Sun Q et al (2014) Thyroid hormone therapy in the management of 63,593 brain-dead organ donors. Transplantation 98:1119–1127PubMed

38.

MacDonald PS, Aneman A, Bhonagiri D et al (2012) A systematic review and meta-analysis of clinical trials of thyroid hormone administration to brain dead potential organ donors. Crit Care Med 40:1635–1644PubMed

39.

Dimopoulou I, Tsagarakis S, Anthi A, Milou E, Ilias I, Stavrakaki K, Charalambidis C, Tzanela M, Orfanos S, Mandragos K, Nikolaos Thalassinos CR (2003) High prevalence of decreased cortisol reserve in brain-dead potential organ donors. Crit Care Med 31:1113–1117PubMed

40.

Dupuis S, Amiel J-A, Desgroseilliers M et al (2014) Corticosteroids in the management of brain-dead potential organ donors: a systematic review. Br J Anaesth 113:346–359PubMed

41.

Pinsard M, Ragot S, Mertes P et al (2014) Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study. Crit Care 18:R158PubMedPubMedCentral

42.

Marvin MR, Morton V (2009) Glycemic control and organ transplantation. J Diabetes Sci Technol 3:1365–1372PubMedPubMedCentral

43.

Casaer MP, Van den Berghe G (2014) Nutrition in the acute phase of critical illness. N Engl J Med 370:1227–1236PubMed

44.

Hahnenkamp K, Böhler K, Wolters H et al (2016) Organ-protective intensive care in organ donors. Dtsch Aerzteblatt Online. Dtsch Arztebl Int 113(33–34):552–558PubMedPubMedCentral

45.

Weiss S, Kotsch K, Francuski M et al (2007) Brain death activates donor organs and is associated with a worse I/R injury after liver transplantation. Am J Transplant 7:1584–1593PubMed

46.

Joseph B, Khalil M, Pandit V et al (2014) Hypothermia in organ donation: a friend or foe? J Trauma Acute Care Surg 77(4):559–563PubMed

47.

Citerio G, Crippa IA, Bronco A et al (2014) Variability in brain death determination in Europe: looking for a solution. Neurocrit Care 21:376–382PubMed

48.

Niemann CU, Feiner J, Swain S et al (2015) Therapeutic hypothermia in deceased organ donors and kidney-graft function. N Eng J Med 373:405–414

49.

Schnuelle P, Mundt HM, Drüschler F et al (2018) Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation. Am J Transplant 18:704–714PubMed

50.

Hébert PC, Carson JL (2014) Transfusion threshold of 7 g per deciliter—the new normal. N Engl J Med 371:1459–1461PubMed

51.

Docherty AB, Turgeon AF, Walsh TS (2018) Best practice in critical care: anaemia in acute and critical illness. Transfus Med 28:181–189PubMed

52.

Coberly EA, Booth GS (2016) Ten-year retrospective review of transfusion practices in beating-heart organ donors. Transfusion 56:339–343PubMed

53.

De La Cruz JS, Sally MB, Zatarain JR et al (2015) The impact of blood transfusions in deceased organ donors on the outcomes of 1,884 renal grafts from United Network for Organ Sharing Region. J Trauma Acute Care Surg 79(4 Suppl 2):S164–S170PubMed

54.

Connor JP, Raife T, Medow JE (2018) Outcomes of red blood cell transfusions prescribed in organ donors by the Digital Intern, an electronic decision support algorithm. Transfusion 58:366–371PubMed

55.

Lisman T, Leuvenink HGD, Porte RJ, Ploeg RJ (2011) Activation of hemostasis in brain dead organ donors: an observational study. J Thromb Haemost 9:1959–1965PubMed

56.

Valdivia M, Chamorro C, Romera MA et al (2007) Effect of posttraumatic donor’s disseminated intravascular coagulation in intrathoracic organ donation and transplantation. Transplant Proc 39:2427–2428PubMed

57.

Garrouste C, Baudenon J, Gatault P et al (2018) No impact of disseminated intravascular coagulation in kidney donors on long-term kidney transplantation outcome: A multicenter propensity-matched study. Am J Transplant 19(2):448–456PubMed

58.

Trotter PB, Robb M, Summers D et al (2017) Donors with immune thrombocytopenia: do they pose a risk to transplant recipients? Am J Transplant 17:796–802PubMed

59.

Fishman JA, Greenwald MA, Grossi PA (2012) Transmission of infection with human allografts: essential considerations in donor screening. Clin Infect Dis 55:720–727PubMed

60.

Aguilar C, Husain S, Lortholary O (2018) Recent advances in understanding and managing infectious diseases in solid organ transplant recipients. F1000Research 7:661

61.

Fischer SA (2019) Is this organ donor safe?: Donor-derived infections in solid organ transplantation. Surg Clin N Am 99:117–128PubMed

62.

Len O, Garzoni C, Lumbreras C et al (2014) Recommendations for screening of donor and recipient prior to solid organ transplantation and to minimize transmission of donor–derived infections. Clin Microbiol Infect 20:10–18PubMed

63.

Vincent J-L, Marshall JC, Namendys-Silva SA et al (2014) Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med 2:380–386PubMed

64.

Organ Procurement and Transplantation Network Guidance for Recognizing Central Nervous System Infections in Potential Deceased Organ Donors. https://optn.transplant.hrsa.gov/resources/guidance/guidance-for-recognizing-central-nervous-system-infections-in-potential-deceased-organ-donors/. Accessed 10 Dec 2018

65.

Nogueira ML, Estofolete CF, Terzian ACB et al (2017) Zika virus infection and solid organ transplantation: a new challenge. Am J Transplant 17:791–795PubMed

66.

Muller E, Barday Z, Mendelson M, Kahn D (2015) HIV-positive–to–HIV-positive kidney transplantation—results at 3 to 5 years. N Engl J Med 372:613–620PubMedPubMedCentral

67.

Schlendorf KH, Zalawadiya S, Shah AS et al (2018) Early outcomes using hepatitis C-positive donors for cardiac transplantation in the era of effective direct-acting anti-viral therapies. J Hear Lung Transplant 37:763–769

68.

Durand CM, Bowring MG, Brown DM et al (2018) Direct-acting antiviral prophylaxis in kidney transplantation from hepatitis C virus-infected donors to noninfected recipients. Ann Intern Med 168:533PubMedPubMedCentral

Titel: Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality
verfasst von: Geert Meyfroidt
Jan Gunst
Ignacio Martin-Loeches
Martin Smith
Chiara Robba
Fabio Silvio Taccone
Giuseppe Citerio
Publikationsdatum: 11.02.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 3/2019
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05551-y

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Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality

Abstract

Purpose

Methods

Results and conclusions

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Results and conclusions

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