The peroperative management in multiple organ donors: a crucial phase in organ transplantation.
Recent developments in organ transplantation led to the fact that any potential cadaver donor might be considered as a multiple organ donor (MOD). The anesthesiologist's role is to maintain good hemodynamic conditions during the long and complex harvesting procedure, taking into account that in renal cadaver transplantation, donor's stable hemodynamic conditions play a crucial role in the immediate function of the graft. Taking the opportunity of a case of simultaneous liver, pancreas and kidneys procurement in the same cadaver donor performed for the first time in our country, we are reviewing the different phases of the donor peroperative management. This implies a strict control of the systolic blood pressure (SBP) and central venous pressure (CVP). The first step was to maintain the blood volume: during the 3 hours procedure, 5.5 liters of crystalloid, 1.2 liters of colloid and 1 liter of blood were perfused to maintain a CVP higher than 8 mm Hg and a SBP above 110 mm Hg. To obtain the best possible renal and hepatic perfusion, 4 micrograms/kg/min. dopamine is injected continuously, along with 100 mg phenoxybenzamine since the beginning of the operation in order to avoid any local arterial spasm. After heparinization (3 mg/kg 10 minutes prior to clamping), all organs are simultaneously perfused in situ with 3 liters of Euro-Collins solution at 4 degrees C, for cold storage in optimal conditions. The pancreas along with one kidney was transplanted in a diabetic women in preterminal end-stage renal disease: current creatinine (2 months post-transplant) is 1.3 mg/dl and C-peptide is 0.8 pmol/ml. The other kidney was successfully transplanted in another center. The liver graft was implanted in a cirrhotic patient: current bilirubin is 6 mg/dl, S.G.O.T. and S.G.P.T. respectively 50 and 149 U.I.(ABSTRACT TRUNCATED AT 250 WORDS)
D001794:Blood Pressure; D002102:Cadaver; D006801:Humans; D007430:Intraoperative Care; D008991:Monitoring, Physiologic / Q000379:methods; D009926:Organ Preservation / Q000379:methods*