Brain death and organ and tissue donor management in the Intensive Care Unit

Authors

DOI:

https://doi.org/10.56294/saludcyt2022201

Keywords:

Brain Death, Organ Preservation, Intensive Care Unit, Organ Donor

Abstract

Introduction: brain death is defined as the irreversible cessation of all brain and brainstem functions. The timely management and maintenance of these vital functions and correction of the physiopathological alterations of the potential donor make organ donation possible, providing a second chance to patients who depend on a transplant. 
Aim: to describe the concept of encephalic death in the patient and its current management as a potential organ and tissue donor in the intensive care unit. 
Methodology: a non-experimental, descriptive, literature review study was carried out.
Results: the process of organ and tissue donation after encephalic death is a challenge in terms of diagnosis and subsequent hemodynamic management with the aim of maintaining tissue perfusion so that these have vitality and viability to be transplanted to the recipient patient.
Conclusions: it is recommended to use an established brain death protocol and apply it correctly, to avoid legal problems. Once the diagnosis has been made, it is possible to carry out the evaluation to establish whether the patient is a donor candidate or not. The pathophysiological changes that appear in the process of BD make these critical patients to be managed with extreme care. Donor maintenance is a major challenge for all health personnel in the intensive care area, since its treatment is extremely complex and the availability of donors is limited compared to the high demand of recipient patients waiting for an organ

References

1. Mishra M. Manejo del Donante con Muerte Cerebral para Trasplante de Órganos [Internet]. World Federation of Societies of Anesthesiologists; 2022. https://resources.wfsahq.org/atotw/manejo-del-donante-con-muerte-cerebral-para-trasplante-de-organos/

2. Aguilar FG, Muguerza LA, Pérez TJM, et al. Impacto del éxito en trasplantes debido al mantenimiento de órganos en terapia intensiva, a propósito de la primera donación multiorgánica en Chiapas, reporte de caso. Med Crit. 2019;33(1):45-49.

3. Escudero Augusto D, Martínez Soba F, de la Calle B, Pérez Blanco A, Estébanez B, Velasco J, et al. Cuidados intensivos orientados a la donación de órganos. Recomendaciones ONT-SEMICYUC. Medicina Intensiva 2021;45:234-42. https://doi.org/10.1016/j.medin.2019.09.018.

4. Al Attar B. Deceased donation after brain death (DBD). Saudi J Kidney Dis Transpl. 2021;32:597-612.

5. Ungerer MN et al. Brain death and treatment of (potential) organ donors and interactions with their relatives. Anästhesiol Intensivmed Notfallmed Schmerzther. 2020;55:453–466. https://doi.org/10.1055/a-1167-1420.

6. Escalante JL, Río F. Preservación de órganos. Med. Intensiva. 2009; 33(6):282-292.

7. Harumy M, Nunes N, Welling LC, Mota JP, Gadelha E. Brain death and management of the potential donor. Neurol Sci. 2021; 42(9): 3541–3552. https://doi.org/10.1007/s10072-021-05360-6.

8. Lewis A. Contentious Ethical and Legal Aspects of Determination of Brain Death. Semin Neurol. 2018;38(5):576-582. https://doi.org/10.1055/s-0038-1668075.

9. Greer D et al. Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. JAMA. 2020;324(11):1078-1097. https://doi.org/10.1001/jama.2020.11586.

10. Drost G, Absalom AR, Kuiper MA. Brain death/death by neurologic criteria determination: an update. Curr Opin Anaesthesiol. 2022;35(5):570-576. https://doi.org/10.1097/aco.0000000000001173.

11. Victorino JP, Mendes KDS, Westin ÚM, Magro JTJ, Corsi CAC, Ventura CAA. Perspectives toward brain death diagnosis and management of the potential organ donor. Nurs Ethics. 2019;26(6):1886-1896. https://doi.org/10.1177/0969733018791335.

12. Bera KD, Shah A, English MR, Harvey D, Ploeg RJ. Optimisation of the organ donor and effects on transplanted organs: a narrative review on current practice and future directions. Anaesthesia. 2020;75(9):1191-1204. https://doi.org/10.1111/anae.15037.

13. Aristizábal AM, Castrillón Y, Gil T, Restrepo D, Guevara M, Solano K, et al. Manejo actual del donante potencial de órganos y tejidos en muerte cerebral: guía de manejo y revisión de la literatura. Rev Colomb Cir 2019;32:128-145. https://doi.org/10.30944/20117582.17.

14. Santibáñez- Velázquez M, Olguín-Sánchez E, Ángeles-Vélez A, García-García BA. Muerte encefálica: actitud y conocimientos del personal médico en un hospital de especialidades. Rev Med Inst Mex Seguro Soc. 2016;54(6):706-12.

15. Michel SG, Madariaga MLL, Muraglia GM, Villani V, Sekijima M, Farkash EA, et al. The effects of brain death and ischemia on tolerance induction are organ-specific. Am J Transplant. 2018;18(5):1262-1269. https://doi.org/10.1111/ajt.14674.

16. Bodí MA, Pont T, Sandiumenge A, Oliver E, Gener J, Badía M, et al. Brain death organ donation potential and life support therapy limitation in neurocritical patients. Med Intensiva. 2015;39(6):337-44. https://doi.org/10.1016/j.medin.2014.07.010.

17. Meyfroidt G, Gunst J, Martin-Loeches I, Smith M, Robba C, Taccone FS, et al. Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality. Intensive Care Med. 2019;45(3):343-353. https://doi.org/10.1007/s00134-019-05551-y.

18. Hahnenkamp K. Organ donation-Responsibility for all intensive care physicians. Anaesthesist. 2021;70(11):909-910. https://doi.org/10.1007/s00101-021-01050-2.

19. Walter U. Brain death criterion and organ donation: current neuroscientific perspective. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2020;63(12):1519-1530. https://doi.org/10.1007/s00103-020-03245-1.

20. Joffe AR, Khaira G, de Caen AR. The intractable problems with brain death and possible solutions. Philos Ethics Humanit Med. 2021;16(1):11. https://doi.org/10.1186/s13010-021-00107-9.

21. Benavente D, Ferro C, Orozco R. Detección y manejo médico del donante fallecido en muerte encefálica. Rev Med Clin Condes. 2010;21(2):166-177. https://doi.org/10.1016/S0716-8640(10)70521-6.

22. Gutiérrez EA. Muerte encefálica o muerte cerebral. Washington D. C., Estados Unidos: Organización Panamericana de la Salud; 2018. https://www3.paho.org/relacsis/index.php/es/foros-relacsis/foro-becker-fci-oms/61-foros/consultas-becker/921-muerte-encefalica-o-muerte-cerebral

23. Ministerio de Salud Pública del Ecuador. Protocolo para el diagnóstico y certificación de la muerte encefálica. Quito: Ministerio de Salud Pública. 2015.

24. Correa DG, de Souza SR, Nunes PGC, Coutinho AC, da Cruz LCH. The role of neuroimaging in the determination of brain death. Radiol Bras. 2022;55(6):365-372. https://doi.org/10.1590/0100-3984.2022.0016.

25. MacDonald D, Stewart-Perrin B, Shankar JJS. The Role of Neuroimaging in the Determination of Brain Death. J Neuroimaging. 2018;28(4):374-379. https://doi.org/10.1111/jon.12516.

26. Ribeiro ER, Junqueira L, Cordeiro V, Ordinola SS. Apnea test for brain death diagnosis in adults on extracorporeal membrane oxygenation: a review. Rev Bras Ter intensiva. 2020;32(2):312-8. https://doi.org/10.5935/0103-507x.20200048.

27. Salim A, Vassiliu P, Velmahos GC, Sava J, Murray JA, Belzberg H, et al. The role of thyroid hormone administration in potential organ donors. Arch Surg. 2001;136:1377-80. https://doi.org/10.1001/archsurg.136.12.1377.

28. Rosendale JD, Kauffman HM, McBride MA, Chabalewski FL, Zaroff JG, Garrity ER, et al. Aggressive pharmacologic donor management results in more transplanted organs. Transplantation. 2003;75:482-7. https://doi.org/10.1097/01.tp.0000045683.85282.93.

29. McKeating EG, Andrews PJ, Signorini DF, Mascia L. Transcranial cytokine gradients in patients requiring intensive care after acute brain injury. Br J Anaesth. 1997;78:520-3. https://doi.org/10.1093/bja/78.5.520.

30. Stangl M, Zerkaulen T, Theodorakis J, Illner W, Schneeberger H, Land W, et al. Influence of brain death on cytokine release in organ donors and renal transplants. Transplant Proc. 2001;33:1284-5. https://doi.org/10.1016/s0041-1345(00)02479-9.

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Published

2022-12-31

How to Cite

1.
Tirado Jiménez KY, Guapisaca Vargas CI, Tirado Rodas EL, Becerra Garzón SN, Pintado Chamba ST. Brain death and organ and tissue donor management in the Intensive Care Unit. Salud, Ciencia y Tecnología [Internet]. 2022 Dec. 31 [cited 2024 Nov. 21];2:201. Available from: https://sct.ageditor.ar/index.php/sct/article/view/74