Functional improvement between brain death declaration and organ harvesting.
BACKGROUND
The quality of harvested organs is crucial for graft survival and for posttransplant evolution. This study sought to investigate the evolution of the functional status of brain death (BD) patients during the period between declaration and organ harvesting (BD duration).


METHODS
The study included all BD patients who underwent organ harvesting between January 2006 and June 2009. We compared the functional status regarding hemodynamics, respiration, kidney and liver function, coagulation, water, electrolytes, and acid-base balance evaluated at the moment of BD declaration (P1) and just before organ harvesting (P2). The results of the comparison were expressed as improvement, stable, or aggravation. We calculated mean values of the functional parameters in P1 and P2 and the statistical significance of the differences.


RESULTS
Twelve BD patients were included in the study. The time interval between P1 and P2 was 16.08 +/- 8.54 hours (range, 6-32). The number of patients with vasopressor support was 9/12 at P1 and 0/12 at P2, oxygenation disturbances 1/12 in P1 and 0/12 in P2, renal dysfunction 9/12 in P1 and 2/12 in P2, liver dysfunction 7/12 in P1 and 1/12 in P2, coagulopathy 4/12 in P1 and 0/12 in P2, hypernatremia 8/12 in P1 and 3/12 in P2, and metabolic acidosis 9/12 in P1 and 1/12 in P2. The overall assessment showed improvement in all patients. The most statistically significant improvement was registered in the cardiovascular, respiratory, renal, liver, and acid-base status (P < .05).


CONCLUSIONS
With early, aggressive, protocolized donor management, functional improvement may be achieved during BD duration.
Grigoras
I
I
University of Medicine and Pharmacy, School of Medicine, Iasi, Romania. grigorasioana@yahoo.com
Blaj
M
M
Chelarescu
O
O
Craus
C
C
Florin
G
G
D000136:Acid-Base Equilibrium; D001777:Blood Coagulation; D001926:Brain Death / Q000331:legislation & jurisprudence / Q000503:physiopathology*; D001930:Brain Injuries; D002319:Cardiovascular System / Q000503:physiopathology; D002423:Cause of Death; D006085:Graft Survival; D006801:Humans; D007677:Kidney Function Tests; D008111:Liver Function Tests; D012383:Romania; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods* / Q000592:standards; D009927:Tissue and Organ Procurement / Q000379:methods / Q000706:statistics & numerical data