| Controversial points in organ donor management. | |
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MedLine Citation:
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PMID: 19857774 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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There are still many controversial aspects regarding which method is best for managing organ donors to prevent, lessen, or even reverse the organ alterations associated with brain death. Fundamental aspects are the management of an adequate perfusion pressure, hormone restoration, and opposition of the inflammatory state associated with brain death. Once volume has been normalized, it is necessary to administer vasoactive drugs, including catecholamines to re-establish the loss of sympathetic tone at the vascular and myocardial level. It is impossible to define the ideal or maximal catecholamine dose because it depends on the donor's vascular tone, vascular reactivity, and pharmacokinetic variability characteristic of critical patients, particularly organ donors. To control early onset of diabetes insipidus, it is necessary to administer desmopressin. At present there are insufficient clinical studies to show the usefulness of triiodothyronine. Furthermore, due to its limited availability, elevated cost, and probable side effects, the use of this hormone is not justified. More importance is being given to the negative influence of the inflammatory state associated with brain death, which has repercussions on organ viability and probably influences the prevalence of rejection episodes. Meanwhile in organ donor management, we recommend the use of 15 mg/kg of methylprednisolone as soon as possible. Contrary to triiodothyronine, the potential benefit of its immunomodulatory effects, its low cost, and the absence of major side effects justify this recommendation. |
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Authors:
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C Chamorro; J A Falcón; J C Michelena |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Transplantation proceedings Volume: 41 ISSN: 1873-2623 ISO Abbreviation: Transplant. Proc. Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-10-27 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0243532 Medline TA: Transplant Proc Country: United States |
Other Details:
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Languages: eng Pagination: 3473-5 Citation Subset: IM |
Affiliation:
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Regional Transplant Coordinator, C/ Plaza Trias Bertran 7, 28020 Madrid, Spain. carlos.chamorroj@salud.madrid.org |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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