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Brain Death: Compliance, Consequences and Care of the Adult Donor

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Intensive Care Medicine
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Abstract

Critical care physicians often certify brain death and may continue the care of those patients who become organ donors. This chapter will review recent publications and current practices in these topic areas with the intent of encouraging compliance with established policies for brain death determination and promoting investigations needed to establish evidence-based treatment guidelines for donor care.

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References

  1. Shewmon DA (1998) Chronic “brain death”: Meta-analysis and conceptual consequences. Neurology 51:1538–1545

    PubMed  CAS  Google Scholar 

  2. Powner DJ, Bernstein IM (2003) Extended somatic support for pregnant women after brain death. Crit Care Med 31:1241–1249

    Article  PubMed  Google Scholar 

  3. Wijdicks EF (2002) Brain death worldwide. Neurology 58:20–25

    Article  PubMed  Google Scholar 

  4. Powner DJ, Hernandez M, Rives TE (2004) Variability among hospital policies for determining brain death in adults. Crit Care Med 32:1284–1288

    Article  PubMed  Google Scholar 

  5. Chang MY, McBride LA, Ferguson MA (2003) Variability in brain death declaration practices in pediatric head trauma patients. Pediatr Neurosurg 39:7–9

    Article  PubMed  Google Scholar 

  6. Wijdicks EF (2001) The diagnosis of brain death. N Engl J Med 344:1215–1221

    Article  PubMed  CAS  Google Scholar 

  7. Shemie SD, Doig C, Dickens B, et al (2006) Severe brain injury to neurological determination of death: Canadian forum recommendations. CMAJ 174: S1–13

    PubMed  Google Scholar 

  8. Levesque S, Lessard MR, Nicole PC, et al (2006) Efficacy of a T-piece system and a continuous positive airway pressure system for apnea testing in the diagnosis of brain death. Crit Care Med 34:2213–2216

    Article  PubMed  Google Scholar 

  9. De Freitas GR, Andre C (2006) Sensitivity of transcranial Doppler for confirming brain death: a prospective study of 270 cases. Acta Neurol Scand 113:426–432

    Article  PubMed  Google Scholar 

  10. Munari M, Zuccetta P, Carollo C, et al (2005) Confirmatory tests in the diagnosis of brain death: comparison between SPECT and contrast angiography. Crit Care Med 33: 2068–2073

    Article  PubMed  Google Scholar 

  11. Palmer S, Bader MK (2005) Brain tissue oxygenation in brain death. Neurocrit Care 2:17–22

    Article  PubMed  Google Scholar 

  12. Jain S, DeGeorgia M (2005) Brain death-associated reflexes and automatisms. Neurocrit Care 3:122–126

    Article  PubMed  Google Scholar 

  13. Cooper DKC, Novitzky D, Wicomb WN (1988) Pathophysiology of brain death in the experimental animal: Extracranial aspects. Transplant Proc 20(Suppl 7):25–28

    PubMed  CAS  Google Scholar 

  14. Van der Woude FJ (2002) Graft immunogenicity revisited: Relevance of tissue-specific immunity, brain death and donor pretreatment. Nephron 91:181–187

    Article  PubMed  Google Scholar 

  15. Land WG (2005) The role of postischemic reperfusion injury and other nonantigen-dependent inflammatory pathways in transplantation. Transplantation 79:505–514

    Article  PubMed  Google Scholar 

  16. Powner DJ (2003) Effects of gene induction and cytokine production in donor care. Prog Transplant 13:9–16

    PubMed  Google Scholar 

  17. Mascia L, Bosma K, Pasero D, et al (2006) Ventilatory and hemodynamic management of potential organ donors: an observational survey. Crit Care Med 34:321–326

    Article  PubMed  Google Scholar 

  18. Totsuka E, Dodson F, Urakami A, et al (1999) Influence of high donor serum sodium levels on early postoperative graft function in human liver transplantation. Liver Transplant Surg 5:421–428

    Article  CAS  Google Scholar 

  19. Wheeldon DR, Potter CDO, Oduro A, Wallwork J, Large SR (1995) Transforming the “unacceptable” donor: outcome from the adoption of a standardized donor management technique. J Heart Lung Transplant 14:734–742

    PubMed  CAS  Google Scholar 

  20. Salim A, Velmahos GC, Brown C, Belzberg H, Demetriades D (2005) Aggressive organ donor management significantly increases the number of organs available for transplantation. J Trauma 58:991–994

    Article  PubMed  Google Scholar 

  21. Salim A, Martin M, Brown C, Belzberg H, Rhee P, Demetriades D (2006) Complications of brain death: frequency and impact on organ retrieval. Am Surg 72:377–381

    PubMed  Google Scholar 

  22. Holmquist M, Chabalewski F, Blount T, Edwards C, McBride V, Pietroski R (1999) A critical pathway: Guiding care of organ donors. Crit Care Nurse 19:84–98

    PubMed  CAS  Google Scholar 

  23. Zaroff JG, Rosengard BR, Armstrong WF, et al (2002) Maximizing use of organs recovered from the cadaver donor: Cardiac recommendations. J Heart Lung Transplant 21:1153–1160

    Article  Google Scholar 

  24. Powner DJ, Darby JM, Kellum JA (2004) Proposed treatment guidelines for donor care. Prog Transplant 14:16–28

    PubMed  Google Scholar 

  25. Wood KE, Becker BN, McCartney JG, D’Alessandro AM, Coursin DB (2004) Care of the potential organ donor. N Engl J Med 351:2730–2739

    Article  PubMed  CAS  Google Scholar 

  26. Shemie SD, Ross H, Pagliarello J, et al (2006) Organ donor management in Canada: recommendations of the Forum on Medical Management to Optimize Donor Organ Potential. CMAJ 174: S13–S30

    PubMed  Google Scholar 

  27. Van den Berghe G, Wilmer A, Hermans G, et al (2006) Intensive insulin therapy in the medical ICU. N Engl J Med 354:449–461

    Article  PubMed  Google Scholar 

  28. Cywes R, Greig PD, Sanabria JR, et al (1992) Effect of intraportal glucose infusion on hepatic glycogen content and degradation, and outcome of liver transplantation. Ann Surg 216: 235–247

    Article  PubMed  CAS  Google Scholar 

  29. Singer P, Shapiro H, Cohen J (2005) Brain death and organ damage: The modulating effects of nutrition. Transplantation 80:1363–1368

    Article  PubMed  Google Scholar 

  30. Powner DJ (2005) Donor care before pancreatic tissue transplantation. Prog Transplant 15: 129–137

    PubMed  Google Scholar 

  31. Powner DJ, Crommett JW (2003) Advanced assessment of hemodynamic parameters during donor care. Prog Transplant 13:249–257

    PubMed  Google Scholar 

  32. Cipolla J, Stawicki S, Spatz D (2006) Hemodynamic monitoring of organ donors: a novel use of the esophageal echo-Doppler probe. Am Surg 72:500–504

    PubMed  Google Scholar 

  33. Orens JB, Boehler A, de Perrot M, et al (2003) A review of lung transplant donor acceptability criteria. J Heart Lung Transplant 22:1183–1200

    Article  PubMed  Google Scholar 

  34. Egan TM, Haithcock JA, Nicotra WA, et al (2006) Ex vivo evaluation of human lungs for transplant suitability. Ann Thorac Surg 81:1205–1213

    Article  PubMed  Google Scholar 

  35. Rosendale JD, Kauffman HM, McBride MA, et al (2003) Hormonal resuscitation yields more transplanted hearts, with improved early function. Transplantation 75:1336–1341

    Article  PubMed  Google Scholar 

  36. Follette DM, Rudich SM, Babcock WD (1998) Improved oxygenation and increased lung donor recovery with high-dose steroid administration after brain death. J Heart Lung Transplant 17:423–429

    PubMed  CAS  Google Scholar 

  37. Powner DJ, Hernandez M (2005) A review of thyroid hormone administration during adult donor care. Prog Transplant 15:202–207

    PubMed  Google Scholar 

  38. Garrity ER, Boettcher H Gabbay E (2005) Donor infection: an opinion on lung donor utilization. J Heart Lung Transplant 24:791–797

    Article  PubMed  Google Scholar 

  39. Zibari GB, Lipka J, Zizzi H, et al (2000) The use of contaminated donor organs in transplantation. Clin Transplantation 14:397–400

    Article  CAS  Google Scholar 

  40. American Thoracic Society and Infectious Diseases Society of America (2005) Guideline for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416

    Article  Google Scholar 

  41. Powner DJ, Reich HS (2000) Regulation of coagulation abnormalities and temperature in organ donors. Prog Transplant 10:146–153

    PubMed  CAS  Google Scholar 

  42. O’Connell KA, Wood JJ, Wise RP, Lozier JN, Braun MM (2006) Thromboembolic adverse events after us of recombinant human coagulation factor VIIa. JAMA 295:293–298

    Article  PubMed  CAS  Google Scholar 

  43. Grounds RM, Seebach C, Knothe C, et al (2006) Use of recombinant activated factor VII (Novoseven) in trauma and surgery: analysis of outcomes reported to an international registry. J Intensive Care Med 21:27–39

    Article  PubMed  Google Scholar 

  44. Pratschke J, Tullius SG, Neuhaus P. (2004) Brain death associated ischemia/reperfusion injury. Ann Transplant 9:78–80

    PubMed  Google Scholar 

  45. Van der Woude FJ, Schnuelle P, Yard BA (2004) Preconditioning strategies to limit graft immunogenicity and cold ischemic organ injury. J Investig Med 52:323–329

    Article  PubMed  Google Scholar 

  46. Azoulay D, Del Gaudio M, Andreani P, et al (2005) Effects of 10 minutes of ischemic preconditioning of the cadaveric liver on the graft’s preservation and function. Ann Surg 242:133–139

    Article  PubMed  Google Scholar 

  47. Totsuka E, Fung JJ, Urakami A, et al (2000) Influence of donor cardiopulmonary arrest in human liver transplantation: Possible role of ischemic preconditioning. Hepatology 31:577–580

    Article  PubMed  CAS  Google Scholar 

  48. Schnuelle P, Yard BA, Braun C, et al (2004) Impact of donor dopamine on immediate graft function after kidney transplantation. Am J Transplant 4:419–426

    Article  PubMed  CAS  Google Scholar 

  49. Beck GC, Brinkkoetter P, Hanusch C, et al (2004) Clinical review: Immunomodulatory effects of dopamine in general inflammation. Crit Care 8:485–491

    Article  PubMed  Google Scholar 

  50. Vincent JL, Piagnerelli M (2006) Transfusion in the intensive care unit. Crit Care Med 34(Suppl):S96–S101

    Article  PubMed  Google Scholar 

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Powner, D.J. (2007). Brain Death: Compliance, Consequences and Care of the Adult Donor. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-49518-7_89

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  • DOI: https://doi.org/10.1007/978-0-387-49518-7_89

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-49517-0

  • Online ISBN: 978-0-387-49518-7

  • eBook Packages: MedicineMedicine (R0)

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