J Korean Soc Transplant.  2014 Jun;28(2):51-58. 10.4285/jkstn.2014.28.2.51.

Management and Evaluation Prior to Transplantation of Deceased Donor

• Jung JH
• Park SK
• Lee S

• KMID: 2202531
• DOI: http://doi.org/10.4285/jkstn.2014.28.2.51

Abstract

The number of people awaiting organ transplantation continues to exceed the number of organs available for transplantation, especially at a time when kidney transplantation is recognized as the best treatment option for end stage renal disease. There may be many reasons for this disparity of organ supply and demand, including the lack of consent, absence of an experienced coordinator team to help in closing the widening gap between organ supply and demand, and an unstandardized critical care management of potential organ donors. According to the report of the Korean Organ Transplant Registry in March 2014, due to a serious organ shortage in Korea, kidneys of deceased donors with low initial estimated glomerular filtration rate of <45 mL/min/1.73 m2 (21.2%) and expanded criteria donors (18.3%) are frequently used, and the number of wife donors and ABO-incompatible transplants for blood type O recipients is increasing. Because the number of donor organs compared with the demand is very restricted, proper management of deceased donors in the intensive care unit has been recognized as a critical determinant for a successful transplantation. Therefore, for successful transplantation of harvested organs, many medical doctors who play an integral role in the transplantation process should understand the pathophysiology of brain death-related systemic changes and well-designed management guidelines should be used prior to transplantation of deceased donors. This article reports on brain death-related systemic changes and proper management for preservation of function of donor organs.

Keyword

Organ transplantation; Organ preservation

MeSH Terms

Brain
Critical Care
Glomerular Filtration Rate
Humans
Intensive Care Units
Kidney
Kidney Failure, Chronic
Kidney Transplantation
Korea
Organ Preservation
Organ Transplantation
Spouses
Tissue Donors*
Transplants

Figure

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  Fig. 1. General approach to the diagnosis of brain death.

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  Fig. 2. The pathophysiological changes according to parts which are injuried in brain.

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  Fig. 3. Protocol for aggressive donor management. Abbreviations: ICU, intensive care unit; MAP, mean arterial pressure; SIADH, syndrome of inappropriate secretion of antidiuretic hormone.

Reference

References

1). Korean Network for Organ Sharing (KONOS). The second quarter 2013 transplant statistis [Internet]. Seoul: KONOS;2013. [cited 2013 Nov 20]. Available from:. http://konos.go.kr.

2). Ahn C, Koo TY, Jeong JC, Kim M, Yang J, Lee J, et al. Initial report of the Korean Organ Transplant Registry: the first report of national kidney transplantation data. Transplant Proc. 2014; 46:425–30.

3). 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; 205:337–40.

4). Practice parameters for determining brain death in adults (summary statement). The Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1995; 45:1012–4.

5). Johnson LS, Subramanian RM. Brain death and cardiac death: donor criteria and care of deceased donor. Morris PJ, Knechtle SJ, editors. ed,. Kidney transplantation: principles and practice. 7th ed.Edinburgh: Saunders, Elsevier;2014. p. 91–104.

6). Kim JG, Yang CW. Management of deceased donor. J Neurocrit Care. 2012; 5:40–3.

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

8). Kim SJ. Organ donor management. J Korean Med Assoc. 2006. 49. ;502–6.

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

10). Rosendale JD, Kauffman HM, McBride MA, Chabalewski FL, Zaroff JG, Garrity ER, et al. Hormonal resuscitation yields more transplanted hearts, with improved early function. Transplantation. 2003; 75:1336–41.