Management of Hemodynamic and Metabolic Impairments in Heart-Beating Donors
Transplantation results are significantly better when organs are obtained from live donors compared with organs from brain-dead and from nonheart- beating donors. This outcome is closely related to acute and widespread physiological changes occurring during brain death that, if untreated, cause organic deterioration and cardiac arrest. Furthermore, inflammatory and hormonal changes, if not carefully diagnosed and treated, may adversely affect donor organ function after transplantation and susceptibility to rejection.
In brain death, the impairments eventually developed are initially caused by the physiological response and then aggravated by the lesion/injury and the medications given. Cardiovascular changes in the donor during the observation period and the harvesting procedure may jeopardize the functionality of potential transplantable organs. The increasing intracranial pressure produces a compensatory arterial hypertension that is followed by sympathetic overactivity, which in turn induces a “catecholamine storm” with increased cardiac output, heart rate, and systemic vascular resistance. Treatment algorithms for donor management in some common clinical settings are shown. Management of glycemic homeostatic derangements, acid-base alterations, fluid, electrolyte changes and pulmonary changes are discussed.
KeywordsUrine Output Central Venous Pressure Disseminate Intravascular Coagulation Brain Death Cerebral Perfusion Pressure
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