[Prevention of organ failure in an organ donor. Early identification and maximum protective therapy after multiple trauma].
BACKGROUND
A 18-year-old woman suffered from severe multi-trauma in combination with acute brain injury (Glasgow Coma Scale Score = 4) after road accident. After prolonged rescue measures and emergency stabilisation the patient was transferred by helicopter to the emergency department of our clinic.


METHODS
Cranial computer tomography showed a severe general cerebral edema and a marked reduction in cerebral perfusion. Additionally, blunt abdominal injury, severe chest injury and multiple fractures were seen. Due to the severe and diffuse brain injury, a neurosurgical intervention was not possible. The patient was transferred to the intensive care unit.


RESULTS
Intensive supportive therapy was started (artificial ventilation, massive transfusion, volume replacement, insertion of a chest tube, renal replacement therapy). Control cerebral computer tomography indicated a complete destruction of the cerebral parenchyma and infarction. Sedation was stopped. After 48-hours of intensive care therapy brain death was stated and the approval for organ donation was given by the next of kin. Heart and kidneys were explanted and transplanted successfully.


CONCLUSIONS
Even under conditions of limited organ functions early identification and maximal supportive therapy may help to supply organ donation. Under certain condition, multiorgan failure may be reversible in possible organ donors.
Bein
Th
T
Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg. thomas.bein@klinik.uni-regensburg.de
Obed
A
A
Schlitt
H J
HJ
D000063:Accidents, Traffic; D000293:Adolescent; D001926:Brain Death / Q000473:pathology; D001930:Brain Injuries / Q000150:complications*; D017809:Fatal Outcome; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D009102:Multiple Organ Failure / Q000517:prevention & control*; D009104:Multiple Trauma / Q000150:complications*; D016377:Organ Transplantation; D014019:Tissue Donors; D014057:Tomography, X-Ray Computed