Gepost in: Organisatie

Management of the brain-dead donor in the ICU: general and specifc therapy to improve transplantable organ quality

Purpose: To provide a practical overview of the management of the potential organ donor in the intensive care unit.

Methods: Seven areas of donor management were considered for this review: hemodynamic management; fuids and electrolytes; respiratory management; endocrine management; temperature management; anaemia and coagu lation; infection management. For each subchapter, a narrative review was conducted.

Results and conclusions: Most elements in the current recommendations and guidelines are based on pathophysi ological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagula tion. Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopres sin, intravenously. Temperature management of the donor is an area of uncertainty, but it appears reasonable to strive for a core temperature of >35 °C. The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. The potential donor should be assessed clinically for infections, and screening tests for specifc infections are an essential part of donor management. Although the rate of infection transmission from donor to receptor is low, certain infections are still a formal con traindication to organ donation. However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.




Geert Meyfroidt, Jan Gunst, Ignacio Martin‑Loeches2, Martin Smith, Chiara Robba, Fabio Silvio Taccone and Giuseppe Citerio


Intensive Care Med (2019) 45:343–353