Skip to main content

Organ Donor Management

  • Chapter
  • First Online:
Book cover Principles of Adult Surgical Critical Care

Abstract

The processes of organ donation and transplantation have developed considerably over the past decades. As early as the beginning of the twentieth century, there were successful reports of transplantation of human skin and cornea [1, 2]. However, it was not until 1954 that the first successful solid organ transplant between identical twins was reported at the Peter Bent Brigham Hospital, Boston [3]. The advancement of immunosuppressive therapy over the years and the improvement in life-sustaining therapy have increased the potentials for cadaveric organ donation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Chick LR. Brief history and biology of skin grafting. Ann Plast Surg. 1988;21(4):358–65.

    CAS  PubMed  Google Scholar 

  2. Zirm ME. Eduard Konrad Zirm and the “wondrously beautiful little window”. Refract Corneal Surg. 1989;5(4):256.

    CAS  PubMed  Google Scholar 

  3. Linden PK. History of solid organ transplantation and organ donation. Crit Care Clin. 2009;25(1):165–84.

    PubMed  Google Scholar 

  4. Beecher H. A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death. JAMA. 1968;205(6):337–40.

    Google Scholar 

  5. United Network for Organ Sharing. History: united network for organ sharing; 2015 [cited 2015 June 01]. Available from: http://www.unos.org/donation/index.php?topic=history.

  6. United Network for Organ Sharing. Transplant trends: united network for organ sharing; 2015 [cited 2015 June 21]. Available from: https://www.unos.org/data/transplant-trends/#transplants_by_donor_type.

  7. U.S. Department of Health and Human Services. Organ donation breakthrough collaborative: from best practice to common practice: U.S. Department of Health and Human Services; 2007 [cited 2007 July 26]. Available from: http://www.organdonationnow.org/.

  8. Department of Health and Human Resources. Centers for disease control and prevention. Injury data and resources: Department of Health and Human Resources; 2007 [cited 2007 July 26]. Available from: http://www.cdc.gov/nchs/injury.htm.

  9. Shafer TJ, Wagner D, Chessare J, Zampiello FA, McBride V, Perdue J. Organ donation breakthrough collaborative increasing organ donation through system redesign. Crit Care Nurse. 2006;26(2):33–48.

    PubMed  Google Scholar 

  10. Franz H, DeJong W, Wolfe S, Reitsma W, Beasley C. Explaining brain death: a critical feature of the donation process. J Transpl Coord. 1997;7(1):14–21.

    CAS  PubMed  Google Scholar 

  11. Shafer TJ, Davis KD, Holtzman SM, Van Buren CT, Crafts NJ, Durand R. Location of in-house organ procurement organization staff in level I trauma centers increases conversion of potential donors to actual donors. Transplantation. 2003;75(8):1330–5.

    PubMed  Google Scholar 

  12. Salim A, Berry C, Ley EJ, Schulman D, Desai C, Navarro S, et al. In-house coordinator programs improve conversion rates for organ donation. J Trauma Acute Care Surg. 2011;71(3):733–6.

    Google Scholar 

  13. Shafer T, Ehrle R, Davis K, Durand R, Holtzman S, Van Buren C, et al. Increasing organ recovery from level I trauma centers: the in-house coordinator intervention. Prog Transplant. 2004;14(3):250–63.

    PubMed  Google Scholar 

  14. Wijdicks EF, Varelas PN, Gronseth GS, Greer DM. Evidence-based guideline update: determining brain death in adults report of the quality standards subcommittee of the American Academy of Neurology. Neurology. 2010;74(23):1911–8.

    PubMed  Google Scholar 

  15. Manno EM, Wijdicks EF. The declaration of death and the withdrawal of care in the neurologic patient. Neurol Clin. 2006;24(1):159–69.

    PubMed  Google Scholar 

  16. Cassel C, Allee M, Beasley C, Beauchamp T, Bentley J, Callender C, et al. Non-heart-beating organ transplantation: practice and protocols. A report of the Committee on Non-Heart-Beating Transplantation II, Institute of Medicine. Washington DC: National Academy Press; 2000.

    Google Scholar 

  17. Howard RJ, Schold JD, Cornell DL. A 10-year analysis of organ donation after cardiac death in the United States. Transplantation. 2005;80(5):564–8.

    PubMed  Google Scholar 

  18. Van Gelder F, de Roey J, Desschans B, Van Hees D, Aerts R, Monbaliu D, et al. Donor categories: heart-beating, non-heart-beating and living donors; evolution within the last 10 years in UZ Leuven and collaborative donor hospitals. Acta Chir Belg. 2008;108(1):35.

    PubMed  Google Scholar 

  19. Potts JT, Herdman R. Non-heart-beating organ transplantation: medical and ethical issues in procurement. Washington DC, USA:National Academies Press; 1998.

    Google Scholar 

  20. Kotloff RM, Blosser S, Fulda GJ, Malinoski D, Ahya VN, Angel L, et al. 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. 2015;43(6):1291–325.

    PubMed  Google Scholar 

  21. Keizer KM, de Fijter JW, Haase-Kromwijk BJ, Weimar W. Non–heart-beating donor kidneys in the Netherlands: allocation and outcome of transplantation. Transplantation. 2005;79(9):1195–9.

    PubMed  Google Scholar 

  22. Chan EY, Olson LC, Kisthard JA, Perkins JD, Bakthavatsalam R, Halldorson JB, et al. Ischemic cholangiopathy following liver transplantation from donation after cardiac death donors. Liver Transpl. 2008;14(5):604–10.

    PubMed  Google Scholar 

  23. Yagci G, Fernandez L, Knechtle S, D’Alessandro A, Chin L, Musat A, et al., editors. The impact of donor variables on the outcome of orthotopic liver transplantation for hepatitis C. Transplantation proceedings. Amsterdam, The Netherlands: Elsevier; 2008.

    Google Scholar 

  24. De Oliveira NC, Osaki S, Maloney JD, Meyer KC, Kohmoto T, D’Alessandro AM, et al. Lung transplantation with donation after cardiac death donors: long-term follow-up in a single center. J Thorac Cardiovasc Surg. 2010;139(5):1306–15.

    PubMed  Google Scholar 

  25. Tuttle-Newhall JE, Collins BH, Kuo PC, Schoeder R. Organ donation and treatment of the multi-organ donor. Curr Probl Surg. 2003;40(5):266–310.

    PubMed  Google Scholar 

  26. Bittner HB, Kendall SW, Chen EP, Craig D, Van Trigt P. The effects of brain death on cardiopulmonary hemodynamics and pulmonary blood flow characteristics. Chest J. 1995;108(5):1358–63.

    CAS  Google Scholar 

  27. Ryan JB, Hicks M, Cropper JR, Garlick SR, Kesteven SH, Wilson MK, et al. Functional evidence of reversible ischemic injury immediately after the sympathetic storm associated with experimental brain death. J Heart Lung Transplant. 2003;22(8):922–8.

    PubMed  Google Scholar 

  28. Novitzky D, Horak A, Cooper D, Rose A, editors. Electrocardiographic and histopathologic changes developing during experimental brain death in the baboon. Amsterdam, The Netherlands: Transplantation proceedings; 1989.

    Google Scholar 

  29. Novitzky T, Cooper DK, Morrell D, Isaacs S. Change from aerobic to anaerobic metabolism after brain death, and reversal following triiodothyronine therapy. Transplantation. 1988;45(1):32–6.

    CAS  PubMed  Google Scholar 

  30. Kusaka M, Pratschke J, Wilhelm MJ, Ziai F, Zandi-Nejad K, Mackenzie HS, et al. Activation of inflammatory mediators in rat renal isografts by donor brain death. Transplantation. 2000;69(3):405–10.

    CAS  PubMed  Google Scholar 

  31. Salim A, Martin M, Brown C, Belzberg H, Rhee P, Demetriades D. Complications of brain death: frequency and impact on organ retrieval. Am Surg. 2006;72(5):377–81.

    PubMed  Google Scholar 

  32. Kolin A, Norris JW. Myocardial damage from acute cerebral lesions. Stroke. 1984;15(6):990–3.

    CAS  PubMed  Google Scholar 

  33. Cooper D, Novitzky D, Wicomb W. The pathophysiological effects of brain death on potential donor organs, with particular reference to the heart. Ann R Coll Surg Engl. 1989;71(4):261.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Wood KE, Becker BN, McCartney JG, D’Alessandro AM, Coursin DB. Care of the potential organ donor. N Engl J Med. 2004;351(26):2730–9.

    CAS  PubMed  Google Scholar 

  35. Zaroff JG, Rosengard BR, Armstrong WF, Babcock WD, D’Alessandro A, Dec GW, et al. Consensus conference report maximizing use of organs recovered from the cadaver donor: cardiac recommendations: March 28–29, 2001, Crystal City. Va Circ. 2002;106(7):836–41.

    Google Scholar 

  36. Rosengard BR, Feng S, Alfrey EJ, Zaroff JG, Emond JC, Henry ML, et al. Report of the Crystal City meeting to maximize the use of organs recovered from the cadaver donor. Am J Transplant. 2002;2(8):701–11.

    PubMed  Google Scholar 

  37. Kutsogiannis DJ, Pagliarello G, Doig C, Ross H, Shemie SD. Medical management to optimize donor organ potential: review of the literature. Can J Anesth. 2006;53(8):820–30.

    PubMed  Google Scholar 

  38. Laffey JG, Engelberts D, Kavanagh BP. Buffering hypercapnic acidosis worsens acute lung injury. Am J Respir Crit Care Med. 2000;161(1):141–6.

    CAS  PubMed  Google Scholar 

  39. Laffey JG, Kavanagh BP. 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. 2000;342(18):1301–8.

    Google Scholar 

  40. Hanna K, Seder CW, Weinberger JB, Sills PA, Hagan M, Janczyk RJ. Airway pressure release ventilation and successful lung donation. Arch Surg. 2011;146(3):325–8.

    PubMed  Google Scholar 

  41. Noiseux N, Nguyen B, Marsolais P, Dupont J, Simard L, Houde I, et al., editors. Pulmonary recruitment protocol for organ donors: a new strategy to improve the rate of lung utilization. Transplantation proceedings. Amsterdam, The Netherlands: Elsevier; 2009.

    Google Scholar 

  42. Avlonitis VS, Krause A, Luzzi L, Powell H, Phillips JA, Corris PA, et al. Bacterial colonization of the donor lower airways is a predictor of poor outcome in lung transplantation. Eur J Cardiothorac Surg. 2003;24(4):601–7.

    PubMed  Google Scholar 

  43. Braverman J. Increasing the quantity of lungs for transplantation using high-frequency chest wall oscillation: a proposal. Prog Transplant. 2002;12(4):266–74.

    PubMed  Google Scholar 

  44. Prodhan P, Casavant D, Medlock M, Yager P, Kim J, Noviski N, editors. Inhaled nitric oxide in neurogenic cardiopulmonary dysfunction: implications for organ donation. Transplantation proceedings. Amsterdam, The Netherlands: Elsevier; 2004.

    Google Scholar 

  45. Schnuelle P, Lorenz D, Mueller A, Trede M, Van Der Woude FJ. Donor catecholamine use reduces acute allograft rejection and improves graft survival after cadaveric renal transplantation 1. Kidney Int. 1999;56(2):738–46.

    CAS  PubMed  Google Scholar 

  46. Gottmann U, Brinkkoetter P, Bechtler M, Hoeger S, Karle C, Schaub M, et al. Effect of pre-treatment with catecholamines on cold preservation and ischemia/reperfusion-injury in rats. Kidney Int. 2006;70(2):321–8.

    CAS  PubMed  Google Scholar 

  47. Totsuka E, Dodson F, Urakami A, Moras N, Ishii T, Lee MC, et al. Influence of high donor serum sodium levels on early postoperative graft function in human liver transplantation: effect of correction of donor hypernatremia. Liver Transpl Surg. 1999;5(5):421–8.

    CAS  PubMed  Google Scholar 

  48. González FX, Rimola A, Grande L, Antolin M, Garcia‐Valdecasas JC, Fuster J, et al. Predictive factors of early postoperative graft function in human liver transplantation. Hepatology. 1994;20(3):565–73.

    PubMed  Google Scholar 

  49. Miner ME, Kaufman HH, Graham SH, Haar FH, Gildenberg PL. Disseminated intravascular coagulation fibrinolytic syndrome following head injury in children: frequency and prognostic implications. J Pediatr. 1982;100(5):687–91.

    CAS  PubMed  Google Scholar 

  50. Hefty TR, Cotterrell LW, Fraser SC, Goodnight SH, Hatch TR. Disseminated intravascular coagulation in cadaveric organ donors incidence and effect on renal transplantation. Transplantation. 1993;55(2):442.

    CAS  PubMed  Google Scholar 

  51. Wheeldon D, Potter C, Oduro A, Wallwork J, Large S. Transforming the “unacceptable” donor: outcomes from the adoption of a standardized donor management technique. J Heart Lung Transplant: Off Publ Int Soc Heart Transplant. 1994;14(4):734–42.

    Google Scholar 

  52. Malinoski DJ, Daly MC, Patel MS, Oley-Graybill C, Foster III CE, Salim A. Achieving donor management goals before deceased donor procurement is associated with more organs transplanted per donor. J Trauma Acute Care Surg. 2011;71(4):990–6.

    Google Scholar 

  53. Salim A, Martin M, Brown C, Rhee P, Demetriades D, Belzberg H. The effect of a protocol of aggressive donor management: implications for the national organ donor shortage. J Trauma Acute Care Surg. 2006;61(2):429–35.

    Google Scholar 

  54. Salter DR, Dyke CM, Wechsler AS. Triiodothyronine (T3) and cardiovascular therapeutics: a review. J Card Surg. 1992;7(4):363–74.

    CAS  PubMed  Google Scholar 

  55. Hadjizacharia P, Salim A, Brown C, Inaba K, Chan LS, Mascarenhas A, et al. Does the use of pulmonary artery catheters increase the number of organs available for transplantation? Clin Transplant. 2010;24(1):62–6.

    PubMed  Google Scholar 

  56. Milano A, Livi U, Casula R, Bortolotti U, Gambino A, Zenati M, et al., editors. Influence of marginal donors on early results after heart transplantation. Transplantation proceedings. 1993.

    Google Scholar 

  57. Cinotti R, Roquilly A, Mahé P-J, Feuillet F, Yehia A, Belliard G, et al. Pulse pressure variations to guide fluid therapy in donors: a multicentric echocardiographic observational study. J Crit Care. 2014;29(4):489–94.

    PubMed  Google Scholar 

  58. Howlett TA, Keogh AM, Perry L, TOUZEL R, REES LH. Anterior and posterior pituitary function in brain-stem-dead donors: a possible role for hormonal replacement therapy. Transplantation. 1989;47(5):828–33.

    CAS  PubMed  Google Scholar 

  59. Chen JM, Cullinane S, Spanier TB, Artrip JH, John R, Edwards NM, et al. Vasopressin deficiency and pressor hypersensitivity in hemodynamically unstable organ donors. Circulation. 1999;100 suppl 2:II-244–Ii-6.

    CAS  Google Scholar 

  60. Hunt SA, Baldwin J, Baumgartner W, Bricker JT, Costanzo MR, Miller L, et al. Cardiovascular management of a potential heart donor: a statement from the transplantation committee of the American College of Cardiology. Crit Care Med. 1996;24(9):1599–601.

    CAS  PubMed  Google Scholar 

  61. Pennefather SH, Bullock RE, Dark JH. The effect of fluid therapy on alveolar arterial oxygen gradient in brain-dead organ donors. Transplantation. 1993;56(6):1418–21.

    CAS  PubMed  Google Scholar 

  62. Callahan DS, Kim D, Bricker S, Neville A, Putnam B, Smith J, et al. Trends in organ donor management: 2002 to 2012. J Am Coll Surg. 2014;219(4):752–6.

    PubMed  Google Scholar 

  63. Masson F, Thicoipe M, Latapie M, Maurette P. Thyroid function in brain-dead donors. Transpl Int. 1990;3(4):226–33.

    CAS  PubMed  Google Scholar 

  64. DuBose J, Salim A. Aggressive organ donor management protocol. J Intensive Care Med. 2008;23(6):367–75.

    PubMed  Google Scholar 

  65. Novitzky D, Cooper D, Reichart B. Value of triiodothyronine (T3) therapy to brain-dead potential organ donors. J Heart Transplant. 1985;5(6):486–7.

    Google Scholar 

  66. Salim A, Vassiliu P, Velmahos GC, Sava J, Murray JA, Belzberg H, et al. The role of thyroid hormone administration in potential organ donors. Arch Surg. 2001;136(12):1377–80.

    CAS  PubMed  Google Scholar 

  67. Salim A, Martin M, Brown C, Inaba K, Roth B, Hadjizacharia P, et al. Using thyroid hormone in brain‐dead donors to maximize the number of organs available for transplantation. Clin Transplant. 2007;21(3):405–9.

    PubMed  Google Scholar 

  68. Salim A, Velmahos GC, Brown C, Belzberg H, Demetriades D. Aggressive organ donor management significantly increases the number of organs available for transplantation. J Trauma Acute Care Surg. 2005;58(5):991–4.

    Google Scholar 

  69. Wicomb W, Cooper D, Novitzky D. Impairment of renal slice function following brain death, with reversibility of injury by hormonal therapy. Transplantation. 1986;41(1):29–32.

    CAS  PubMed  Google Scholar 

  70. Blasi-Ibanez A, Hirose R, Feiner J, Freise C, Stock P, Roberts J, et al. Predictors associated with terminal renal function in deceased organ donors in the intensive care unit. Anesthesiology. 2009;110(2):333.

    PubMed  Google Scholar 

  71. Gnudi L, Thomas SM, Viberti G. Mechanical forces in diabetic kidney disease: a trigger for impaired glucose metabolism. J Am Soc Nephrol. 2007;18(8):2226–32.

    CAS  PubMed  Google Scholar 

  72. Hostetter TH, Troy JL, Brenner BM. Glomerular hemodynamics in experimental diabetes mellitus. Kidney Int. 1981;19(3):410–5.

    CAS  PubMed  Google Scholar 

  73. Deng W, Han Q, Liao L, Li C, Ge W, Zhao Z, et al. Allogeneic bone marrow–derived flk-1+ Sca-1− mesenchymal stem cells leads to stable mixed chimerism and donor-specific tolerance. Exp Hematol. 2004;32(9):861–7.

    CAS  PubMed  Google Scholar 

  74. Murugan R, Venkataraman R, Wahed AS, Elder M, Hergenroeder G, Carter M, et al. Increased plasma interleukin-6 in donors is associated with lower recipient hospital-free survival after cadaveric organ transplantation. Crit Care Med. 2008;36(6):1810–6.

    CAS  PubMed  Google Scholar 

  75. van der Hoeven JA, Ter Horst GJ, Molema G, de Vos P, Girbes AR, Postema F, et al. Effects of brain death and hemodynamic status on function and immunologic activation of the potential donor liver in the rat. Ann Surg. 2000;232(6):804.

    PubMed  PubMed Central  Google Scholar 

  76. Kuecuek O, Mantouvalou L, Klemz R, Kotsch K, Volk H, Jonas S, et al., editors. Significant reduction of proinflammatory cytokines by treatment of the brain-dead donor. Transplantation proceedings. Amsterdam, The Netherlands: Elsevier; 2005.

    Google Scholar 

  77. Kotsch K, Francuski M, Pascher A, Klemz R, Seifert M, Mittler J, et al. Improved long‐term graft survival after HO‐1 induction in brain‐dead donors. Am J Transplant. 2006;6(3):477–86.

    CAS  PubMed  Google Scholar 

  78. Follette DM, Rudich SM, Babcock WD. Improved oxygenation and increased lung donor recovery with high-dose steroid administration after brain death. J Heart Lung Transplant: Off Publ Int Soc Heart Transplant. 1998;17(4):423–9.

    CAS  Google Scholar 

  79. Wetzel RC, Setzer N, Stiff JL, Rogers MC. Hemodynamic responses in brain dead organ donor patients. Anesth Analg. 1985;64(2):125–8.

    CAS  PubMed  Google Scholar 

  80. Gelb AW, Robertson KM. Anaesthetic management of the brain dead for organ donation. Can J Anaesth. 1990;37(7):806–12.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ali Salim MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Olufajo, O.A., Salim, A. (2016). Organ Donor Management. In: Martin, N.D., Kaplan, L.J. (eds) Principles of Adult Surgical Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-33341-0_38

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33341-0_38

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33339-7

  • Online ISBN: 978-3-319-33341-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics