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ORGAN DONATION
Miloš Chobola
Intensive Care Medicine

Adobe Systems
Intensive Care Medicine – (VLAM9X1c)
Educational outcome :
§identify potential organ donor
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§understand what si the definition of neurological death
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§understand what are the prerequisites before testing
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§know what tests are used to confirm neurological death
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Adobe Systems
Intensive Care Medicine – (VLAM9X1a)
Introduction :
§Organ transplantation is a recognised treatment for end organ damage
§ It is an altruistic act of beneficence resulting in the gift of life
§transplantation is life-enhancing for pancreatic and renal diseases
§transplantation is life- saving for end stage heart, lung and liver diseases
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Adobe Systems
Intensive Care Medicine – (VLAM9X1a)
Donor identification :
§Defined clinical trigger factors in patients who have had a catastrophic brain injury.
§The absence of one or more cranial nerve reflexes and a Glasgow Coma Score of 5 or less, which is
not explained by confounders.
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§GIVE score
§AE, ICU, neurology/stroke units

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Donor identification :
§A consistent clinical indicator used for the early identification of potential organ and tissue
donors
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                                     Curran Emer,  2020, Irish Organ Donation Handbook app, version
5.10, MEG Software
Intensive Care Medicine – (VLAM9X1a)

Adobe Systems
Intensive Care Medicine – (VLAM9X1a)
Criteria for organ donation :
§the process of organ donation places a huge importance on the balance of risk and benefit to the
recipient
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§potential organ donor (family) /potential organ recipient
§primary team /ICU / neurology/ surgeons/ organ donation coordinator.......
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§suboptimal transplant outcomes :graft dysfunction , disease transmission, recipientś death

Adobe Systems
Intensive Care Medicine – (VLAM9X1a)
Criteria for organ donation :
§absolute contraindications :
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§no consent from next of kin
§no consent from coroner (IRL/UK) – cause of death
§family dissent/conflict about donation
§advanced-stage disease     (colon stage > T3 or breast > T1c)

Adobe Systems
Intensive Care Medicine – (VLAM9X1a)
Criteria for organ donation :
§relative contraindications to donation :
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§sepsis, HIV positive, systemic viral infection , herpetic meningoencephalitis, neoplasms (
lymphoma, malignant melanoma,...), lung cancer, glioblastoma, ....
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§early stage disease cancers (bowel and breast) can be acceptable for organ donation depending on
staging and the disease- free interval

Adobe Systems
Intensive Care Medicine – (VLAM9X1a)
Neurological death
DBD (donation after brain death) :
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§definition :
§the irreversible loss of consciousness due to a known cause
§ loss of brain reflexes
§ apnoea in the presence of  respiratory acidemia

Adobe Systems
Intensive Care Medicine – (VLAM9X1a)
Neurological death :
§aetiology :
§cerebral haemorrhage, cerebrovascular embolism, hypoxic brain injury, , traumatic brain injury,
meningitis, brain tumour, epilepsy, brain abscess, hydrocephalus,..
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§tests :brain stem test
              apnoea test
§ancillary tests – radiology, audiometry,EEG, transcranial  Doppler

Adobe Systems
Intensive Care Medicine – (VLAM9X1a)
Neurological death – prerequisites :
§known cause of death
§drug free state – no sedatives, no muscle relaxants, no anesthetic agents, alcohol, opiods,....
§normothermia > 36 °C
§avoid electrolyte imbalance , Na 130-155mmol/L, normal blood glucose levels, ....
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§no endocrine imbalance

Adobe Systems
Intensive Care Medicine – (VLAM9X1a)
Brainstem tests, apnoea test :
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Curran Emer,  2020, Irish Organ Donation Handbook app, vrsion 5.10, MEG Software

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ICU managment of potential organ donor :
§ICU principles :
§maintain euvoleamia
§optimise cardiac output
§lung protective ventilation
§diabetes insipidus- Na/UO/
§prevent hypothermia
§glyceamia control, (thyroid hormones, glucocortikoids, ...)
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Intensive Care Medicine – (VLAM9X1a)

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Donation after circulatory death (DCD) :
§DCD – refers to the retrieval of organs for the purpose of transplantation from patients whose
death is diagnosed and confirmed using cardio-respiratory criteria
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§controlled           /uncontrolled
expected            /unexpected
§ICU, stroke unit /emergency department, out of hospital
§UK, Australia     /France, Spain                                                   .
   both Netherlands
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Intensive Care Medicine – (VLAM9X1a)

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Perioperative management :
§maintain clinical targets as in „normal“ patient
§no need for opiods
§muscle relaxants  usually needed
§low dose of sevoflurane (inhalational anesthetics) improves outcome
•
Intensive Care Medicine – (VLAM9X1a)

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Family approach :
§principles
§Care of the dying patient is of paramount importance!!!
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§Measures to maintain the comfort and dignity of the patient must not be compromised for organ
donation
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Intensive Care Medicine – (VLAM9X1a)

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Family approach :
§use clear language
§obtain the patient’s clinical history
§identify key family members
§identify key family issues, including the need for family support
§identify relevant cultural and religious issues
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§all religions support the ethos of organ donation
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Intensive Care Medicine – (VLAM9X1a)

Adobe Systems
Donor identification summary :
Intensive Care Medicine – (VLAM9X1a)
Curran Emer,  2020, Irish Organ Donation Handbook app, vrsion 5.10, MEG Software

Adobe Systems
Intensive Care Medicine – (VLAM9X1a)
Take home message :
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§ existence of organ donation program
§organ donation program is a multidisciplinary task
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§dealing with a family is very delicate matter

Adobe Systems
Intensive Care Medicine – (VLAM9X1a)
thank you

Lékařská fakulta Masarykovy univerzity
2021
Adobe Systems