Published online Jun 18, 2023. doi: 10.5500/wjt.v13.i4.183
Peer-review started: December 20, 2022
First decision: February 20, 2023
Revised: February 28, 2023
Accepted: April 21, 2023
Article in press: April 21, 2023
Published online: June 18, 2023
Processing time: 177 Days and 16.9 Hours
In brain death donors (BDDs), donor management is the key in the complex donation process. Donor management goals, which are standards of care or clinical parameters, have been considered an acceptable barometer of successful donor management.
Meeting donor management goals has been associated with an increased number of retrieved organs per donor and, more recently, a reduced incidence of delayed graft function.
To test the hypothesis that aetiology of brain death could influence haemodynamic management in BDDs.
Haemodynamic data (blood pressure, heart rate, central venous pressure, lactate, urine output, and vasoactive drugs) were recorded on intensive care unit (ICU) admission and during the 6-h observation period (Time 1 at the beginning; Time 2 at the end).
The study population was divided three groups according to aetiology of brain death: Stroke (n = 71), traumatic brain injury (n = 48), and postanoxic encephalopathy (n = 19). On ICU admission, BDDs with postanoxic encephalopathy showed the lowest values of SBP and DBP associated with higher values of heart rate and lactate and a higher need of norepinephrine and other vasoactive drugs. At the beginning of the 6-h period (Time 1), BDDs with postanoxic encephalopathy showed higher values of heart rate, lactate, and central venous pressure together with a higher need of other vasoactive drugs.
According to our data, haemodynamic donor management is affected by the aetiology of brain death. BDDs with postanoxic encephalopathy have higher requirements for norepinephrine and other vasoactive drugs.
Our data underscore the utility of the relevant data on potential organ donors being reported to a national registry and how this can be used to drive practice improvement and eventually to develop consensus statements.