Learning objectives
- Specify the adverse effects on organs after the diagnosis of death
- Describe the active management of the donor’s physiology to optimize the quality of organs donated
- Outline the associated anesthesia interventions
Definition and mechanisms
- Organ donation and transplantation is removing an organ from one person (the donor) and surgically placing it in another (the recipient) whose organ has failed
- Death can be diagnosed by somatic, circulatory, and neurological criteria
- DBD: Donation after Brain Death
- At least 2 physicians must declare brain death
- DCD: Donation after Cardiac Death
- A DCD donor has suffered a severe non-recoverable brain insult
- DCD donor’s death is declared based on cardiopulmonary criteria after withdrawal of life support
- Organ procurement can only start 5 minutes after death is declared
Active management of potential organ donors
| Parameter | Target |
|---|---|
| Heart rate | 60-120 beats/min |
| Arterial pressure | Systolic pressure > 100 mmHg Mean pressure ≥ 70 mmHg |
| Central venous pressure | 6-10 mmHg |
| Urine output | 0.5-3 ml/kg/h |
| Electrolytes | Serum sodium 130-150 mmol/L Normal potassium, calcium, magnesium, phosphate Glucose 4-8 mmol/L |
| Blood gases | pH 7.35-7.45 PaCO2 4.7-6 kPa PaO2 ≥ 10.7 kPa SPO2 saturation > 95% |
| Pulmonary capillary wedge pressure | 6-10 mmHg |
| Cardiac index | 2.4 L/min/m |
| Systemic vascular resistance | 800-1200 dyn/s/cm |
Management
- Trauma and potential for multi-organ involvement
- Pulmonary/cardiac contusion
Suggested reading
- Balogh J. Srikar J, Diaz G, Williams GW, Moguilevitch M. The role of anesthisiologists in organ donation. Transplantation reports. 2022;7(4).
- Corbett S, Trainor D, Gaffney A. Perioperative management of the organ donor after diagnosis of death using neurological criteria. BJA Educ. 2021;21(5):194-200.
- McKeown DW, Bonser RS, Kellum JA. Management of the heartbeating brain-dead organ donor. Br J Anaesth. 2012 Jan;108 Suppl 1:i96-107.
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