The Role of Anesthesiologists in Preoperative and Intraoperative Management of Deceased Organ Donors

Abstract

THE SUMMARY O rgan transplantation has revolutionized the management of many chronic diseases. Whilst it is a complex process, it can offer individuals with end stage organ failure improved quality of life, freedom from the burden of on-going treatment and improved survival. Transplanted organs can come from living and deceased donors. Unfortunately there is a persistent gap between the numbers of patients on waiting lists for organ transplants and the availability of suitable organs. This has fuelled renewed interest in deceased donation after circulatory death and brain stem death. The definition and diagnosis of death are central to deceased organ donation. Death can be legally and formally defined as either circulatory death or brain death. Clear guidance on how both circulatory and brain death are defined has been provided by several regulatory bodies such as the Academy of Medical Royal Colleges in the UK and the American Medical Association in the USA. Circulatory death is defined as the irreversible cessation of circulatory function whilst brain death is the irreversible loss of function of the brain and brain stem. Organ retrieval and subsequent transplantation can occur after both donation after brain death (DBD) and donation after circulatory death (DCD).

The intensivist has an important role in the process of identification of patients who are potentially suitable donors as early as possible, through a systematic approach. While recognizing that, clinical situations vary identification should be based on either of the following criteria: defined clinical trigger factors in patients who have had a catastrophic brain injury, or life-limiting condition which is expected to result in circulatory death. The management of the brain dead or circulatory dead donor is a challenge for the ICU physician and the anesthesiologist, thus a multidisciplinary team must have a good understanding regarding the adverse pathophysiological changes that occur. Understanding these abnormalities assist the physician in taking the right decisions to enhance the potential organ graft function and increase the organ supply.