[Evaluation and maintenance of the lung donor].
Spain has a rate of 34.4 donors per million population, making it the country with the highest rate of organ donation all over the world. In spite of these values, need of lungs for transplantation is always greater than the number of organs obtained. The adrenergic storming produced during brain herniation and the initiation of a brain death condition entail a series of pathophysiological alterations that can endanger the lung viability. In this paper, we review the evaluation of lung donor and its maintenance. In all the potential lung donors, the Apnea Test with CPAP should be done and the criteria for the donation of the lung under ideal conditions and with expanded criteria lung donors are reviewed. The protocol of aggressive maintenance including a protective ventilation strategy, restricted fluid intake, use of prophylactic antibiotics, corticosteroids and the systematic use of measures aimed at avoiding alveolar collapse together with maneuvers aimed at achieving better lung recruitment can improve the management of the lung donor and obtain a greater number of organs for transplantation.
Del Río
Francisco
F
Servicio de Medicina Intensiva. Hospital Clínico San Carlos. Madrid. España. frio.hcsc@salud.madrid.org
Escudero
Dolores
D
De La Calle
Braulio
B
Vidal
Federico Gordo
FG
Paredes
María Valentín
MV
Núñez
José Ramón
JR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001049:Apnea; D001926:Brain Death / Q000175:diagnosis / Q000503:physiopathology; D045422:Continuous Positive Airway Pressure; D000075202:Contraindications; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D016040:Lung Transplantation / Q000706:statistics & numerical data; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D018579:Patient Selection; D012121:Respiration, Artificial; D014019:Tissue Donors / Q000706:statistics & numerical data; D014022:Tissue Survival / Q000187:drug effects / Q000502:physiology; D020858:Tissue and Organ Harvesting / Q000379:methods* / Q000592:standards
D000900:Anti-Bacterial Agents; D008775:Methylprednisolone