Organ donor management: Eight common recommendations and actions that deserve reflection.
Despite major advances in our understanding of the physiopathology of brain death (BD), there are important controversies as to which protocol is the most appropriate for organ donor management. Many recent reviews on this subject offer recommendations that are sometimes contradictory and in some cases are not applied to other critically ill patients. This article offers a review of the publications (many of them recent) with an impact upon these controversial measures and which can help to confirm, refute or open new areas of research into the most appropriate measures for the management of organ donors in BD, and which should contribute to discard certain established recommendations based on preconceived ideas, that lead to actions lacking a physiopathological basis. Aspects such as catecholamine storm management, use of vasoactive drugs, hemodynamic objectives and monitoring, assessment of the heart for donation, and general care of the donor in BD are reviewed.
Servicio de Medicina Intensiva, HU Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain. Electronic address: carlos.chamorroj@salud.madrid.org.
C
C
Chamorro-Jambrina
Servicio de Medicina Crítica, HU San José TEC Salud, Monterrey, N.L., Mexico.
M R
MR
Muñoz-Ramírez
Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain.
J L
JL
Martínez-Melgar
Servicio de Medicina Crítica, Hospital General del Estado Dr. Ernesto Ramos Bours, Hermosillo, Sonora, Mexico.
M S
MS
Pérez-Cornejo
D001926:Brain Death / Q000175:diagnosis; D002395:Catecholamines / Q000378:metabolism; D003422:Critical Care / Q000592:standards; D004750:Enteral Nutrition; D006439:Hemodynamics; D006801:Humans; D017410:Practice Guidelines as Topic; D013727:Terminal Care / Q000592:standards; D013963:Thyroid Hormones / Q000627:therapeutic use; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000592:standards; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D002395:Catecholamines; D013963:Thyroid Hormones; D014662:Vasoconstrictor Agents
Brain death; Catecholamine storm; Echocardiogram; Ecocardiograma; Enteral nutrition; Fármacos vasoactivos; Hipotermia; Hormonal supplementation; Hypothermia; Mechanical ventilation; Monitoring; Monitorización; Muerte encefálica; Nutrición enteral; Organ donor management; Reposición hormonal; Tormenta catecolamínica; Tratamiento del donante de órganos; Vasoactive drugs; Ventilación mecánica