Experience of nurses in the process of donation of organs and tissues for transplant (original) (raw)
Related papers
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.
Brain death and management of the potential donor
Neurological Sciences
One of the first attempts to define brain death (BD) dates from 1963, and since then, the diagnosis criteria of that entity have evolved. In spite of the publication of practice parameters and evidence-based guidelines, BD is still causing concern and controversies in the society. The difficulties in determining brain death and making it understood by family members not only endorse futile therapies and increase health care costs, but also hinder the organ transplantation process. This review aims to give an overview about the definition of BD, causes, physiopathology, diagnosis criteria, and management of the potential brain-dead donor. It is important to note that the BD determination criteria detailed here follow the AAN's recommendations, but the standard practice for BD diagnosis varies from one country to another.
Brain Death and Management of the Potential Organ Donor
Textbook of Neurointensive Care, 2013
The concept of brain death has developed remarkably over the years (Table 1). As early as the 12th century, Rabbi Moses Maimonides, an intellectual figure of medieval Conflicts of Interest: The authors have no relevant conflicts of interest to declare. Disclosures: None.
The Physiology of Brain Death and Organ Donor Management
Pediatric Critical Care Medicine, 2014
Brain death is associated with complex physiologic changes that may impact the management of the potential organ donor. Medical management is critical to actualizing the individual or family's intent to donate and maximizing the benefi t of that intent. This interval of care in the PICU begins with brain death and consent to donation and culminates with surgical organ procurement. During this phase, risks for hemodynamic instability and compromise of end organ function are high. The brain dead organ donor is in a distinct and challenging pathophysiologic condition that culminates in multifactorial shock. The potential benefi ts of aggressive medical management of the organ donor may include increased number of donors providing transplantable organs and increased number of organs transplanted per donor. This may improve graft function, graft survival, and patient survival in those transplanted. In this chapter, pathophysiologic changes occurring after brain death are reviewed. General and organ specifi c donor management strategies and logistic considerations are discussed. There is a signifi cant opportunity for enhancing donor multi-organ function and improving organ utilization with appropriate PICU management.
PubMed, 2003
Transplantation has been incorporated into the treatment of patients with end-stage diseases of most major organ systems in recent years. However, organ supply is the greatest limitation to organ transplantation. Among the factors that can enhance organ supply, donor management has received the least attention. The importance of establishing an acceptable method of rapidly and accurately determining brain death in potential donors cannot be overemphasized. With an increased awareness of donor management issues and the application of a rational physiological approach, the supply of functional organs for transplantation can be increased. Rapid and continuing resuscitation of clinically brain-dead trauma victims is mandatory. This review addresses the evaluation and management of the organ donor within the emergency department. Common management problems (hypotension, arrhythmias, diabetes insipidus, oliguria, and coagulopathy) are discussed in detail. An aggressive, proactive approach to the medical management of the potential donor is recommended in order to limit the number of medical failures and maximize the number of organs donated.
Medical Management of Brain-Dead Organ Donors
Acute and Critical Care, 2019
Medical Management of Brain-Dead Organ Donors With improving healthcare services, the demand for organ transplants has been increasing daily worldwide. Deceased organ donors serve as a good alternative option to meet this demand. The first step in this process is identifying potential organ donors. Specifically, braindead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. Some transplant centers follow their own treatment protocols, whereas other countries, such as Bangladesh, do not have any protocols for potential organ donor care. In this review, we discuss how to identify brain-dead donors and describe the physiological changes that occur following brain death. We then summarize the management of brain-dead organ donors and, on the basis of a review of the literature, we propose recommendations for a treatment protocol to be developed in the future.