Experience of nurses in the process of donation of organs and tissues for transplant (original) (raw)
Brain death and care of the organ donor
Brain death has implications for organ donation with the potential for saving several lives. Awareness of maintenance of the brain dead has increased over the last decade with the progress in the field of transplant. The diagnosis of brain death is clinical and can be confirmed by apnea testing. Ancillary tests can be considered when the apnea test cannot be completed or is inconclusive. Reflexes of spinal origin may be present and should not be confused against the diagnosis of brain death. Adequate care for the donor targeting hemodynamic indices and lung protective ventilator strategies can improve graft quality for donation. Hormone supplementation using thyroxine, antidiuretic hormone, corticosteroid and insulin has shown to improve outcomes following transplant. India still ranks low compared to the rest of the world in deceased donation. The formation of organ sharing networks supported by state governments has shown a substantial increase in the numbers of deceased donors primarily by creating awareness and ensuring protocols in caring for the donor. This review describes the steps in the establishment of brain death and the management of the organ donor. Material for the review was collected through a Medline search, and the search terms included were brain death and organ donation. Abstract [Downloaded free from http://www.joacp.org on Thursday, May 26, 2016, IP: 14.96.25.217] Kumar: Brain death and care of the organ donor
Nursing care of the potential donor of organs after brain death: integrative review
Journal of Nursing Ufpe Online, 2012
Objectives: to characterize the scientific literature on the maintenance of the potential multiple organ donor after brain death and highlight relevant aspects to nursing. Methods: this is an integrative review of the literature guided by the formulation of the question: what knowledge has been produced about the maintenance of the potential organs and tissues donor?. For research refinement, the following inclusion criteria were set: publications in Portuguese, English and Spanish; available for free in full texts; published from January 2005 to December 2011; and approaching the theme proposed. For this purpose, the following descriptors were used: "Organ donors", "Brain death" and "Nursing"; obtained from LILACS, SCIELO, BDENF, ISI Knowledge and SCOPUS databases. A total of 15 publications were selected. Using a structured form was made the read of articles. The collected data was typed in the Microsoft Excel 2007 spreadsheets, analyzed through the descriptive statistics, presented in tables and organized into topics. Results: The search identified publications mostly of descriptive type, with qualitative method of data processing, published in the years 2009 and 2010. The results highlight the proper maintenance of the potential donor after brain death as the most promising way to reduce the shortage of organs, because it minimizes the effects of physiological changes and increases effective potential donors. Conclusion: The activities carried out by nursing in maintaining the potential donor of organs are considerably complex and require knowledge ranging from legislation to physiopathological changes resulting from brain death. Descriptors: organ donors; brain death; nursing.
Care of the brain-dead organ donor
Current Anaesthesia & Critical Care, 2007
There remains a worldwide shortage of organs for transplantation. If not properly cared for, the organs of patients who are brainstem dead will deteriorate, making them either unsuitable for transplantation or reducing the success rate of transplants. The Medline database was searched with no time limit in January 2019 for English publications using keywords "brainstem death physiology" and "organ donor care." Full texts of all publications related to care of deceased donors after brainstem death (DBD) were reviewed. Those that were not relevant were excluded. An online search for publications and guidelines produced by international organizations relating to organ donation and care of the organ donor was also preformed, and the results were reviewed. Although there is a low level of evidence to support specific management strategies to optimize the care of potential DBD patients, there is reasonable consensus between different international guidelines on protocolized intensive care unit (ICU) management of potential DBD patients and donor resuscitation targets. Key management concepts include (1) early recognition of brainstem DBD and referral to organ donation services, (2) ICU-led multidisciplinary team (MDT) approach to donor management, (3) shift in ICU teams thinking from management of raised intracranial pressure (ICP) to maintaining organ perfusion and function, (4) early active donor management to normalize donor physiology, and (5) prevention, recognition, and treatment of complications of brainstem death.
Our Brain Death and Organ Donation Experience: Over 12 Years
Transplantation Proceedings, 2019
PURPOSE Nowadays, as the number of patients waiting for organ transplant is increasing, it is important to diagnose brain death in intensive care units and to provide good donor care. We aimed to share our experience of donor care with the diagnosis of brain death in our clinic. MATERIAL AND METHOD One hundred and fifty-one patients diagnosed in our clinic with brain death between June 2006 to 2018 were studied retrospectively. FINDINGS The mean age of the 151 patients was 46.6 (1-89) years. Fifty-seven (37.7%) of the 151 patients' families accepted donation. Ten out of 57 patients could not be organ donors for medical reasons. Eighty-four kidneys, 7 hearts, and 40 livers were transplanted to the patients. When the diagnosis at admission to the intensive care unit was examined, it was found that the most common diagnosis was intracranial hemorrhage (36.8%), followed by head trauma (21.05%), drowning in water (3.5%), and firearm injury (3.5%). The apnea test was applied to all cases, but 17 patients could not complete the apnea test. In order to support the diagnosis of brain death, in 63% of patients (n = 95) radiological methods were performed. Cranial computed tomography angiography was performed as a radiological method. All cases were found to have received at least 1 inotropic support. We used dopamine in 41 patients, noradrenaline in 36 patients, dobutamine in 8 patients, and adrenaline in 3 patients. During the 12 months when the organ transplant coordinator was not on duty, there were no organ donors. It is important to maintain an organ and tissue transplant coordinator and an intensive care unit team for organ donation. CONCLUSION In order to increase the cadaver donor pool, it is necessary to increase the number of brain death diagnoses and decrease the rate of family rejection. Therefore, patients with poor neurologic prognosis should be carefully monitored for brain death. Successful family discussions by an experienced and trained organ transplant coordinator should try to increase donation rates by emphasizing the importance of organ donation and the fact that brain death is a real death.
Guidelines for the assessment and acceptance of potential brain-dead organ donors
Revista Brasileira de Terapia Intensiva, 2016
Diretrizes para avaliação e validação do potencial doador de órgãos em morte encefálica ABSTRACT causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.
2013
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Brain Death and Management of Potential Organ Donor: An Indian Perspective
Indian Journal of Critical Care Medicine, 2019
Organ donation is the most rewarding medical care which has saved many lives. The organ donation rate in India have increased from a dismal 0.05 per million population to 0.8 per million population in a span of few years. 1 Organ donation rates in India are minuscule compared to Croatia's 36.5, Spain's 35.3, and America's 26 per million, respectively. The vast difference between the demand for organs and their poor supply is the main issue of concern. 2 Over 147,913 fatalities were attributed to road traffic accidents in India, in the year 2017. 3,4 In nearly 40-50% of road accident fatalities, the cause of death was head injury. If 5-10% of all brain-dead patients are considered for organ harvesting, there would be no requirement for a living person to donate organs. 2 In 1994, brainstem death was legalized in India. The Transplantation of Human Organs (THO) Act of 1994 and the subsequent amendments in 2011 and 2014 form the legislative foundation for brain death declaration and organ donation. 5-7 The criteria for brainstem death declaration in our country is based on United Kingdom guidelines. 5-7 Because all the potential donor enter ICU at some point of time, intensivist have important role in giving care to potential organ donor 8 (Table 1). Who is Potential Brain-dead Donor (PBDD)? A potential organ donor is defined by the presence of either brainstem death or a catastrophic and irreversible brain injury that leads to fulfilling the brainstem death criteria. 9 What is Brainstem Death? "Brainstem death" means the stage at which all brain functions are permanently and irreversibly ceased. However, the cause of irreversible coma has to be established, preconditions should be met, and confounding factors are to be ruled out. Care of Potential Organ Donor Organ donation system requires early identification of PBDD and early appropriate evaluation and conversion of PBDD to actual donors. Up to 20% of organs and a large number of PBDDs are lost because the clinical management is challenging. This can be overcome with the use of bedside checklists to achieve cardiovascular, respiratory and endocrine-metabolic targeted physiology. Adequate time should be given for organ optimization and to come out of the autonomic storm injury. A median time of around 48 hours from autonomic storm to cardiac function recovery has been proven by serial echocardiographic. Ignacio
Evaluation of Non-donor Brain-Dead Patients
Istanbul Medical Journal
Patients with chronic organ failure receive organs from living donors or brain-dead donors. In our country, brain death and organ transplantation procedures are carried out with Turkish Laws #2238 on the Harvesting, Storage, Grafting, and Transplantation of Organs and Tissues (June 3, 1979). Improvements in legislation have been made on the criteria of diagnosis of brain death and how diagnosis will be made. The recommendation for termination of life support of non-donor brain-dead patients was removed. Due to this uncertainty, hesitancy arises in terms of the discontinuation of life support among healthcare workers. In our study, we aimed to draw attention to the issue about the fate of non-donor brain-dead patients. Methods: In our study, we retrospectively evaluated data of brain-dead patients between January 1, 2011 and June 1, 2017 in our hospital. Results: Of the 122 patients with brain death, 102 were not donors. The mean lifetime of non-donor patients was 29±56 hours. It was observed that cardiac death occurred in the longest surviving patient after 116 hours following declaration. Thirty-five patients were given new vasopressor or inotropic drugs after brain death. Conclusion: The brain-dead person is considered medically and legally dead despite heartbeats. It is not reasonable to maintain the life support of the individual who is considered dead. Considering the insufficient number of intensive care units and the high cost of medical support, it is of great importance to establish legal arrangements that will allow the discontinuation of medical support that is useless in non-donor brain-dead patients and enable the use of life-supporting devices for the patients in the waiting list.
There are currently two sources of organ for transplantation in India i.e., from a living donor or from a brain stem dead donor. Living donation is possible for two organs only i.e., a part of liver or a single kidney. Organ donation from brain stem dead is sharp focus keeping in view the risks associated with live donation. Organ donation from brain stem dead gives life to more than 7 persons by donating organs like two kidneys, liver, pancreas, heart, two lungs and in very rare cases intestines too. These brain stem dead donors can donate tissues too like eyes, bones, skin etc. which is otherwise possible from every dead person. Brain stem dead person is a dependent patient who is breathing through a ventilator but still has a pulse, blood pressure and other signs of life. Brain stem death holds that the lack of functioning of the brain is the truest sign of death and that the rest of the body soon stops functioning even if the ventilator is continued. (Lori Hartwell)i. A person diagnosed brain stem dead is not able to breathe on his own and is on ventilator (a machine which does breathing for him) in ICU'S. Such person can be declared brain stem dead by a team of four medical professionals. Once it is established that he is in irreversible coma there are a few specified tests done on the potential donor twice with a minimum gap of six hours. The actual time of death entered in official papers is the second time of death declaration done by the team of four designated doctors.