Document Detail


[The protocol for multi organ donor management].
MedLine Citation:
PMID:  20201348     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Identification and preparation of a potential organ donor requires careful and meticulous intensive care, so that the organs may be harvested in the best possible condition for transplantation. The protocol consists of three key elements: (1) monitoring and haemodynamicstabilisation, (2) hormonal therapy, and (3) adequate mechanical ventilation and nosocomial pneumonia prophylaxis. Standard haemodynamic monitoring should consist of a 12 lead EGG, and direct monitoring of arterial and central venous pressures. Pulmonary artery catheterisation is indicated in donors with a left ventricular ejection fraction (LVEF) below 45%. PCWP should be kept at around 12 mm Hg, Cl at greater than 2.4 L m(-2), and SVR between 800 and 1200 dyn s(-1) cm(-5). When a vasopressor is necessary, vasopressin should be used as the drug of choice. If vasopressin is not available, noradrenaline or adrenaline may be used. Haemoglobin concentration should be maintained between 5.5-6.2 mmol L(-1). In a potential heart donor, troponin concentration should be checked daily. Neutral thermal conditions should be maintained using a warm air blower. A brain dead patient cannot maintain adequate pituitary function, therefore hormone replacement therapy with methylprednisolone, thyroxin and desmopressin is indicated. Glucose concentrations should be kept within the normal range, using insulin if necessary. The lung harvesting protocol should be similarto ARDS treatment guidelines (optimal PEEP, low tidal volumes). Lung recruitment manoeuvres, and aggressive prevention and treatment of nosocomial infection are essential.
Authors:
Ewa Kucewicz; Jacek Wojarski; Sławomir Zegleń; Wojciech Saucha; Tomasz Maciejewski; Jerzy Pacholewicz; Roman Przybylski; Piotr Knapik; Marian Zembala
Publication Detail:
Type:  English Abstract; Journal Article; Review    
Journal Detail:
Title:  Anestezjologia intensywna terapia     Volume:  41     ISSN:  0209-1712     ISO Abbreviation:  Anestezjol Intens Ter     Publication Date:    2009 Oct-Dec
Date Detail:
Created Date:  2010-03-05     Completed Date:  2010-04-09     Revised Date:  2012-10-05    
Medline Journal Info:
Nlm Unique ID:  9424972     Medline TA:  Anestezjol Intens Ter     Country:  Poland    
Other Details:
Languages:  pol     Pagination:  246-52     Citation Subset:  IM    
Affiliation:
'Oddział Kliniczny Kardioanestezji i Intensywnej Terapii Slaskiego Uniwersytetu Medycznego, Slaskie Centrum Chorób Serca w Zabrzu. kardanest@sum.edu.pl
Vernacular Title:
Przygotowanie dawcy do pobrania wielonarzqdowego--standard postepowania.
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MeSH Terms
Descriptor/Qualifier:
Clinical Protocols
Cross Infection / prevention & control
Heart Function Tests
Hormone Replacement Therapy
Humans
Lung Transplantation / methods
Monitoring, Intraoperative / methods
Pneumonia, Ventilator-Associated / prevention & control
Tissue Donors
Tissue and Organ Harvesting / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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