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Medical management to optimize donor organ potential: review of the literature

[Traitement médical pour optimaliser le potentiel de don d’organe : une revue documentaire]

Demetrios J. Kutsogiannis, MD^*, Giuseppe Pagliarello, MD, Christopher Doig, MD, Heather Ross, MD and Sam D. Shemie, MD^¶

^* From the Division of Critical Care Medicine and Public Health Sciences,University of Alberta, Edmonton, Alberta; the
Department of Surgery and Critical Care Medicine, University of Ottawa, Ottawa, Ontario;
Adult Critical Care, Foothills Hospital, University of Calgary, Calgary, Alberta;
Cardiac Transplant Program, University Health Network, University of Toronto, Toronto, Ontario; and the
^¶ Division of Pediatric Critical Care, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada.

Address correspondence to: Dr. Demetrios J. Kutsogiannis, MMC 102-7, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, Alberta T5H 3V9, Canada. Phone: 780-735-5387; Fax: 780-735-4032; E-mail: dkutsogi{at}telusplanet.net

Purpose: Over the past two decades, the demand for donor organs continues to outpace the number of organs available for transplantation. Parallel with this has been a change in the demographics of organ donors with an increase in older donors and donors with marginal organs as a proportion of the total organ donor pool. Consequently, efforts have been made to improve the medical care delivered to potential organ donors to improve the conversion rate and graft survival of available organs. The purpose of this literature review is to provide updated recommendations for the contemporary management of organ donors after the neurological determination of death in order to maximize the probability of recipient graft survival.

Sources: A comprehensive review of the literature obtained through searches of MEDLINE/PubMed, and personal reference files.

Principal findings: Contemporary management of the organ donor after neurological determination of death includes therapies to prevent the detrimental effects of the autonomic storm, the use of invasive hemodynamic monitoring and aggressive respiratory therapy including therapeutic bronchoscopy in marginal heart and lung donors, and the use of hormonal therapy including vasopressin, corticosteroids, triiodothyronine or thyroxine, and insulin for the pituitary failure and inflammation seen in brain dead organ donors. The importance of normalizing donor physiology to optimize all available organs is stressed.

Conclusion: Aggressive hemodynamic and respiratory management of solid organ donors, coupled with the use of hormonal therapy improves the rate of conversion and graft survival in solid organ recipients.

This article has been cited by other articles:

				S. D. Shemie Brain arrest to neurological determination of death to organ utilization: the evolution of hospital-based organ donation strategies in Canada/De l'arret cerebral a la determination neurologique de la mort et a l'utilisation d'organes : l'evolution du don d'organes en milieu hospitalier au Canada. Can J Anesth, August 1, 2006; 53(8): 747 - 752. [Full Text] [PDF]