Organ-Protective Intensive Care in Organ Donors.
BACKGROUND
The ascertainment of brain death (the irreversible, total loss of brain function) gives the physician the opportunity to limit or stop further treatment. Alternatively, if the brain-dead individual is an organ donor, the mode of treatment can be changed from patient-centered to donationcentered. Consensus-derived recommendations for the organ-protective treatment of brain-dead organ donors are not yet available in Germany.


METHODS
This review is based on pertinent publications retrieved by a selective search in PubMed, and on the authors' clinical experience.


RESULTS
Brain death causes major pathophysiological changes, including an increase in catecholamine levels and a sudden drop in the concentration of multiple hormones, among them antidiuretic hormone, cortisol, insulin, and triand tetraiodothyronine. These changes affect the function of all organ systems, as well as the hemodynamic state and the regulation of body temperature. The use of standardized donor management protocols might well increase the rate of transplanted organs per donor and improve the quality of the transplanted organs. In addition, the administration of methylprednisolone, desmopressin, and vasopressin could be a useful supplement to treatment in some cases. Randomized controlled trials have not yet demonstrated either improved organ function or prolonged survival of the transplant recipients.


CONCLUSIONS
The evidence base for organ-protective intensive care is weak; most of the available evidence is on the level of expert opinion. There is good reason to believe, however, that the continuation of intensive care, in the sense of early donor management, can make organ transplantation more successful both by increasing the number of transplantable organs and by improving organ quality.
Department of Anesthesiology and Intensive Care Medicine, University Medicine Greifswald, German Organ Transplantation Foundation, North-East Donor Region, Berlin, Department of General and Visceral Surgery, University Hospital Münster, Department of Thoracic and Cardiovascular Surgery, University Hospital Münster, Department of Anaesthesiology and Intensive Care, University Hospital Leipzig, Department of Transplant Medicine, University Hospital Münster.
Klaus
K
Hahnenkamp
Klaus
K
Böhler
Heiner
H
Wolters
Karsten
K
Wiebe
Dietmar
D
Schneider
Hartmut H-J
HH
Schmidt
D001926:Brain Death / Q000175:diagnosis*; D003422:Critical Care / Q000941:ethics / Q000592:standards*; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D018802:Patient-Centered Care / Q000592:standards*; D014019:Tissue Donors / Q000941:ethics*; D009927:Tissue and Organ Procurement / Q000941:ethics / Q000592:standards*