An Update on ICU Management of the Potential Organ Donor

Abstract

Solid organ transplantation was one of the great advances in medicine in the 20th century. Indications and demand for transplantation have, however, led to a chronic shortage of transplantable organs. Although donation rates have increased over the past decade, many patients die while waiting for a transplant [1]. In September 2009, there were 103,000 patients awaiting transplantation in the United States [2]. The development of artificial organs continues, but in the short to medium term the medical community will continue to rely on organs retrieved from recently-deceased patients. The majority of organs are procured from patients who have suffered a devastating neurologic injury and have progressed to brainstem death. In recent years, programs have been developed to allow organ donation after cardiac death, though such donors account for less than 10 % of all organs transplanted. Unfortunately, many individuals who satisfy criteria for becoming organ donors fail to donate, mainly because of lack of consent [3]. In others, a suboptimal number of organs are recovered. The greatest discrepancy between supply and demand exists for lungs and only 7–22 % of multiple-organ donors are deemed suitable to become lung donors. (Non-conversion' occurs for two main reasons: In 10–20 % of cases, the patient succumbs to somatic death (i.e., cardiac arrest) after brainstem death but before organs can be retrieved [4]; in other cases, organs are deemed unsuitable for donation because of their condition. ‘Optimization’ of such organs has been the focus of initiatives by organ procurement organizations. The Organ Donation and Transplantation Breakthrough Collaborative, the latest initiative of the United States Health Resources and Service Administration, seeks to meet the goals of 3.75 organs transplanted per donor and a 75 % conversion rate for all potential organ donors.