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brain death donor anesthesia

Michael J Souter, E Eidbo, James Y Findlay, Daniel J Lebovitz, Marina Moguilevitch, Nikole A Neidlinger, Gerhard Wagener, Anil S Paramesh, Claus U Niemann, Pamela R Roberts, Ernesto A Pretto
Worldwide 715 482 patients have received a lifesaving organ transplant since 1988. During this time, there have been advances in donor management and in the perioperative care of the organ transplant recipient, resulting in marked improvements in long-term survival. Although the number of organs recovered has increased year after year, a greater demand has produced a critical organ shortage. The majority of organs are from deceased donors; however, some are not suitable for transplantation. Some of this loss is due to management of the donor...
June 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Vera von Dossow, Joseph Costa, Frank D'Ovidio, Nandor Marczin
Transplantation is sadly a therapy to die for. The survival of a recipient with end-stage heart or lung disease requires the demise of a human being through brain death or cessation of circulation, with the noblest final act of offering one's organs to another. However, transplantation is constrained by severe hemodynamic, regulatory, inflammatory, and metabolic stresses in the donor, rendering the majority of offered organs unsuitable for transplantation. Coupled with our inability to acquire exact molecular and cellular information and missed opportunities for effectively modulating deteriorations of donors and allografts, anesthesia and critical care contributes to ongoing organ shortages...
June 2017: Best Practice & Research. Clinical Anaesthesiology
Mohamed Y Rady, Joseph L Verheijde
Death is defined in the Quran with a single criterion of irreversible separation of the ruh (soul) from the body. The Quran is a revelation from God to man, and the primary source of Islamic knowledge. The secular concept of death by neurological criteria, or brain death, is at odds with the Quranic definition of death. The validity of this secular concept has been contested scientifically and philosophically. To legitimize brain death for the purpose of organ donation and transplantation in Muslim communities, Chamsi-Pasha and Albar (concurring with the US President's Council on Bioethics) have argued that irreversible loss of capacity for consciousness and breathing (apneic coma) in brain death defines true death in accordance with Islamic sources...
April 2018: Journal of Religion and Health
I Freytag, J Bucher, M Schoenberg, M Stangl, G Schelling
We report a case of a 27-year-old anesthetist who acquired tuberculosis (TB) while performing general anesthesia in a renal transplant (RTX) patient who had donor-derived contagious TB. The anesthetist developed pleural TB 6 months after exposure. Contact investigations (CIs) did not include health care workers (HCWs) of the Department of Anesthesiology, thereby missing the opportunity for the early diagnosis and treatment of TB. Genomic fingerprinting revealed identical Mycobacterium tuberculosis (MT) isolates in the anesthetist and in the RTX patient...
May 2016: Der Anaesthesist
Nicoline V Krogstrup, Mihai Oltean, Bo M Bibby, Gertrude J Nieuwenhuijs-Moeke, Frank J M F Dor, Henrik Birn, Bente Jespersen
INTRODUCTION: Delayed graft function due to ischaemia-reperfusion injury is a frequent complication in deceased donor renal transplantation. Experimental evidence indicates that remote ischaemic conditioning (RIC) provides systemic protection against ischaemia-reperfusion injury in various tissues. METHODS AND ANALYSIS: 'Remote ischaemic conditioning in renal transplantation--effect on immediate and extended kidney graft function' (the CONTEXT study) is an investigator initiated, multicentre, randomised controlled trial investigating whether RIC of the leg of the recipient improves short and long-term graft function following deceased donor kidney transplantation...
August 20, 2015: BMJ Open
T Anthony Anderson, Peter Bekker, Parsia A Vagefi
PURPOSE: While a few publications specify the anesthetic implications of either brain or cardiac death, they lack detail on how to provide anesthesia during organ donation surgery. We provide a thorough description of important anesthetic considerations during organ donation surgery in patients with either brain or cardiac death. SOURCE: A thorough literature review was undertaken to locate all relevant articles that describe systemic effects of brain and cardiac death and their anesthetic implications...
May 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Tomoki Hatakeyama, Hirofumi Nagata, Hiroko Miura, Ayako Inoda, Tasuku Suzuki, Kenji Suzuki
We experienced a case in which brain death liver transplantation was suspended after admission to the operating room because the impaired oxygenation was aggravated. A 32-year-old man (weight 70 kg, height 164 cm) who had previously undergone living donor liver transplantation for Budd-Chiari syndrome developed hepatic failure 11 months after the transplantation and was enrolled in the waiting list for brain death liver transplantation. Mechanical ventilation and blood purification therapy were performed in the intensive care unit because he was in coma and his respiratory function had gradually worsened...
March 2014: Masui. the Japanese Journal of Anesthesiology
L Puybasset, J-E Bazin, S Beloucif, P Bizouarn, S Crozier, B Devalois, B Eon, F Fieux, E Gisquet, C Guibet-Lafaye, N Kentish, A Lienhart, A Nicolas-Robin, M Otero Lopez, C Pelluchon, F Roussin, L Beydon
The ethics committee of the French Society of Anesthesia and Intensive Care (Sfar) has been requested by the French Biomedical Agency to consider the issue of organ donation in patients after the decision to withdraw life-supportive therapies has been taken. This type of organ donation is performed in the USA, Canada, the United Kingdom, the Netherlands and Belgium. The three former countries have published recommendations formalizing procedures and operations. The French Society of Anesthesia and Intensive Care (Société française d'anesthésie et de reanimation [Sfar]) ethics committee has considered this issue and envisioned the different aspects of the whole process...
February 2014: Annales Françaises D'anesthèsie et de Rèanimation
I A Silva, C J Correia, R Simas, C D J Correia, J W M C Cruz, S G Ferreira, F L Zanoni, L Menegat, P Sannomiya, L F P Moreira
BACKGROUND: After brain death (BD) donors usually experience cardiac dysfunction, which is responsible for a considerable number of unused organs. Causes of this cardiac dysfunction are not fully understood. Some authors argue that autonomic storm with severe hemodynamic instability leads to inflammatory activation and myocardial dysfunction. OBJECTIVES: To investigate the hypothesis that thoracic epidural anesthesia blocks autonomic storm and improves graft condition by reducing the inflammatory response...
September 2012: Transplantation Proceedings
Branko Bojovic, Amir H Dorafshar, Emile N Brown, Michael R Christy, Daniel E Borsuk, Helen G Hui-Chou, Cynthia K Shaffer, T Nicole Kelley, Paula J Sauerborn, Karen Kennedy, Mary Hyder, Philip S Brazio, Benjamin Philosophe, Rolf N Barth, Thomas M Scalea, Stephen T Bartlett, Eduardo D Rodriguez
BACKGROUND: Transplantation of a facial vascularized composite allograft is a highly complex procedure that requires meticulous planning and affords little room for error. Although cadaveric dissections are an essential preparatory exercise, they cannot simulate the true clinical experience of facial vascularized composite allograft recovery. METHODS: After obtaining institutional review board approval to perform a facial vascularized composite allograft research procurement, a 66-year-old, brain-dead donor was identified...
October 2012: Plastic and Reconstructive Surgery
Vanessa Stadlbauer, Philipp Stiegler, Philipp Taeubl, Michael Sereinigg, Andreas Puntschart, Andrea Bradatsch, Pero Curcic, Thomas Seifert-Held, Gerda Zmugg, Tatjana Stojakovic, Barbara Leopold, Daniela Blattl, Vera Horki, Ursula Mayrhauser, Iris Wiederstein-Grasser, Bettina Leber, Günther Jürgens, Karlheinz Tscheliessnigg, Seth Hallström
BACKGROUND: Literature is controversial whether organs from living donors have a better graft function than brain dead (BD) and non-heart-beating donor organs. Success of transplantation has been correlated with high-energy phosphate (HEP) contents of the graft. METHODS: HEP contents in heart, liver, kidney, and pancreas from living, BD, and donation after cardiac death in a pig model (n=6 per donor type) were evaluated systematically. BD was induced under general anesthesia by inflating a balloon in the epidural space...
April 2013: Journal of Surgical Research
S Steen, T Sjöberg, Q Liao, G Bozovic, B Wohlfart
BACKGROUND: Circulatory instability is a serious problem after brain death in organ donors. The hypotension is often counteracted with infusion of large amounts of crystalloid solutions, which may impair lung function leading to rejection of the lungs as donor organs. The aim was to show that the circulation can be normalized pharmacologically for 24 h in pigs after total removal of the brain and brainstem by decapitation (between C2 and C3). METHODS: Twenty-four 40-kg pigs (n = 8 × 3) were included: non-decapitated, decapitated, and decapitated with pharmacological treatment...
September 2012: Acta Anaesthesiologica Scandinavica
Waiel A Almoustadi, Trevor W R Lee, Julianne Klein, Kanwal Kumar, Rakesh C Arora, Ganghong Tian, Darren H Freed
Brain death (BD) causes cardiac dysfunction in organ donors, attributable to the catecholamine storm that occurs with raised intracerebral pressure (ICP). However the direct contribution of the spinal sympathetics has not been well described. We examined the effect of total spinal anesthesia (TSA) on cardiac function in a large animal model of BD. Eighteen pigs were allocated to 3 experimental groups: Group 1, the saline-treated control group; Group 2, TSA administered prior to BD; and Group 3, TSA administered 30 min after BD...
September 2012: Canadian Journal of Physiology and Pharmacology
Bernhard Floerchinger, Xiaodong Yuan, Anke Jurisch, Marc-Olivier Timsit, Xupeng Ge, Ying-Lung Lee, Christof Schmid, Stefan G Tullius
BACKGROUND: Brain death impairs donor organ quality and accelerates immune responses after transplantation. Detailed aspects of immune activation following brain death remain unclear. We have established a mouse model and investigated the immediate consequences of brain death and anesthesia on immune responses. METHODS: C57JBl/6 mice (n=6/group) were anesthetized with isoflurane (ISF) or ketamine/xylazine (KX); subsequently, animals underwent brain death induction and were followed for 3h under continuous ventilation...
August 2012: Transplant Immunology
C Boutin, F Vachiéry-Lahaye, S Alonso, G Louart, A Bouju, S Lazarovici, P-F Perrigault, X Capdevila, S Jaber, P Colson, O Jonquet, J Ripart, J-Y Lefrant, L Muller
BACKGROUND: The aim of this study was to report current anaesthetic management brain-dead organ donors and to assess its impact on delayed kidney graft function (DGF). METHODS: To achieve this retrospective multicenter study, brain-dead patient records were analysed for the years 2005 to 2007. Expanded donor criteria, length of stay in ICU, duration of brain death, respect of recommended cold ischemia time, preoperative and intraoperative management, type of anaesthesia, hemodynamic and respiratory parameters during organ retrieval, and impact of anaesthesia on DGF were analysed...
May 2012: Annales Françaises D'anesthèsie et de Rèanimation
David Rodríguez-Arias, Maxwell J Smith, Neil M Lazar
Despite continuing controversies regarding the vital status of both brain-dead donors and individuals who undergo donation after circulatory death (DCD), respecting the dead donor rule (DDR) remains the standard moral framework for organ procurement. The DDR increases organ supply without jeopardizing trust in transplantation systems, reassuring society that donors will not experience harm during organ procurement. While the assumption that individuals cannot be harmed once they are dead is reasonable in the case of brain-dead protocols, we argue that the DDR is not an acceptable strategy to protect donors from harm in DCD protocols...
August 2011: American Journal of Bioethics: AJOB
Hirobumi Okawa, Tomoko Ono, Eiji Hashiba, Toshihito Tsubo, Hironori Ishihara, Kazuyoshi Hirota
We report the use of perioperative bispectral index (BIS) monitoring in a patient who underwent living donor liver transplantation (LDLT). Hepatic encephalopathy featuring extreme excitement developed in a 42-year-old male and was diagnosed as acute hepatitis. Sedation with continuous infusion of midazolam was necessary. BIS value gradually decreased and reached 0 17 h after commencement of continuous infusion of midazolam. Midazolam infusion was stopped but BIS value remained 0. Brain CT scan revealed an almost normal image...
February 2011: Journal of Anesthesia
Laurie J Elkins
Organs needed for transplantation far outweigh their availability. There is minimal research regarding perioperative care of the brain-dead organ donor during the procurement procedure. Current research attributes a great deal of organ damage to autonomic or sympathetic storm that occurs during brain death. Literature searches were performed with the terms brain death, organ donor, organ procurement, anesthesia and organ donor, anesthesia and brain death, anesthesia and organ procurement, inhalational anesthetics and organ procurement, and inhalational anesthetics and brain dead...
August 2010: AANA Journal
Vito Fanelli, Luciana Mascia
PURPOSE OF REVIEW: One of the newest strategies to enlarge the pool of organ donors is to consider the category of donors after cardiac death rather than only after brain death. Prompt and accurate identification of potential donors and appropriate care is necessary to optimize the management of nonheartbeating donors. RECENT FINDINGS: Organ procurement derived from donors after cardiac death is becoming a part of the policy of major transplantation hospitals, forcing them to consider the practical interventions and ethical implications regarding this practice...
June 2010: Current Opinion in Anaesthesiology
David B Auyong, Stephen M Klein, Tong J Gan, Anthony M Roche, Daiwai Olson, Ashraf S Habib
We present a case series of increased bispectral index values during donation after cardiac death (DCD). During the DCD process, a patient was monitored with processed electroencephalogram (EEG), which showed considerable changes traditionally associated with lighter planes of anesthesia immediately after withdrawal of care. Subsequently, to validate the findings of this case, processed EEG was recorded during 2 other cases in which care was withdrawn without the use of hypnotic or anesthetic drugs. We found that changes in processed EEG immediately after withdrawal of care were not only reproducible, but can happen in the absence of changes in major electromyographic or electrocardiographic artifact...
May 1, 2010: Anesthesia and Analgesia
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