scholarly journals Scintigraphic Evaluation of Renal Function in Heart-Beating Brain Death Patients Using Technetium-99m Diethylenetriamine Pentaacetic Acid

Nephron ◽  
1992 ◽  
Vol 62 (2) ◽  
pp. 238-238
Author(s):  
Belkis Erbas ◽  
Günaydin Erbengi ◽  
Tülin Aras ◽  
Aykut Erbengi
Keyword(s):  
Renal Function ◽  
Brain Death ◽  
Technetium 99M ◽  
Heart Beating ◽  
Diethylenetriamine Pentaacetic Acid

Donor organ management

2021 ◽  
pp. 691-705
Author(s):  
Arne P Neyrinck ◽  
Patrick Ferdinande ◽  
Dirk Van Raemdonck ◽  
Marc Van de Velde
Keyword(s):  
Brain Death ◽  
Treatment Strategies ◽  
Organ Donor ◽  
Hormonal Changes ◽  
Physiological Changes ◽  
Donor Pool ◽  
Potential Donor ◽  
Donor Management ◽  
Heart Beating ◽  
Pituitary Thyroid Axis

Organ transplantation is the standard treatment modality for end-stage organ disease in selected cases. Two types of potential organ donors can be identified: the brain-dead 'heart-beating donors', referred to as DBD (donation after brain death), and the warm ischaemic 'non-heart-beating donors', referred to as DCD (donation after circulatory death). Brain death induces several physiological changes in the DBD donor. An autonomic storm is characterized by massive catecholamine release, followed by autonomic depletion during a vasoplegic phase. This is associated with several hormonal changes (suppression of vasopressin, the hypothalamic-pituitary-adrenal axis, and the hypothalamic-pituitary-thyroid axis) and an inflammatory response. These physiological changes form the basis of organ donor management, including cardiovascular stabilization and hormonal therapy (including vasopressin and analogues, thyroid hormone, and cortisol). Donor management is the continuation of critical care, with a shift towards individual organ stabilization. An aggressive approach to maximize organ yield is recommended; however, many treatment strategies need further investigation in large randomized trials. DCD donors have now evolved as a valid alternative to increase the potential donor pool and challenge the clinician with new questions. Optimal donor comfort therapy and end-of-life care are important to minimize the agonal phase. A strict approach towards the determination of death, based on cardiorespiratory criteria, is prerequisite. Novel strategies have been developed, using ex situ organ perfusion as a tool, to evaluate and recondition donor organs. They might become more important in the future to further optimize organ quality.

scholarly journals Medico-Legal Aspects of Renal Transplantation

1983 ◽  
Vol 11 (4) ◽  
pp. 345-349
Author(s):  
A. G. R. Sheil
Keyword(s):  
Renal Transplantation ◽  
Public Education ◽  
Brain Death ◽  
Organ Transplantation ◽  
Medical Profession ◽  
Public Support ◽  
Legal Aspects ◽  
Cardiopulmonary Support ◽  
Number Of Patients ◽  
Heart Beating

Advances in clinical tissue and organ transplantation have enforced changes in legislation concerning the disposal of bodies and their parts. With the evolution of cardiopulmonary support systems came the concept of brain death. To enable physicians to withdraw support without transgressing the law, recognition in law of brain death was necessary. To ensure that the diagnosis of brain death was certain, eminent doctors in advanced communities have drawn up criteria of brain death which are widely recognised and applied with confidence by the medical profession. Organs for transplantation are best obtained from “heart beating cadavers”. Despite public support for organ transplantation the requirements for organs to treat those presenting are not currently being met even though the number of patients who die and who could be suitable donors far exceeds that required. Increased public education to stimulate voluntary donation is necessary. Standardisation of care of comatose patients in hospitals is also required so that brain death may be diagnosed when it occurs. If the procedures for organ donation are familiar and well understood, suitable patients can then become donors according to their own or their relatives’ wishes.

Donor organ management

2015 ◽  
Author(s):  
Arne P Neyrinck ◽  
Patrick Ferdinande ◽  
Dirk Van Raemdonck ◽  
Marc Van de Velde
Keyword(s):  
Brain Death ◽  
Treatment Strategies ◽  
Ex Situ ◽  
Hormonal Changes ◽  
Physiological Changes ◽  
Donor Pool ◽  
Potential Donor ◽  
Donor Management ◽  
Aggressive Approach ◽  
Heart Beating

Organ transplantation is the standard treatment modality for end-stage organ disease in selected cases. Two types of potential organ donors can be identified: the brain-dead ‘heart-beating donors’, referred to as DBD (donation after brain death), and the warm ischaemic ‘non-heart-beating donors’, referred to as DCD (donation after circulatory death). Brain death induces several physiological changes in the DBD donor. An autonomic storm is characterized by massive catecholamine release, followed by autonomic depletion during a vasoplegic phase. This is associated with several hormonal changes (suppression of vasopressin, the hypothalamic-pituitary-adrenal axis, and the hypothalamic-pituitary-thyroid axis) and an inflammatory response. These physiological changes form the basis of organ donor management, including cardiovascular stabilization and hormonal therapy (including vasopressin and analogues, thyroid hormone, and cortisol). Donor management is the continuation of critical care, with a shift towards individual organ stabilization. An aggressive approach to maximize organ yield is recommended; however, many treatment strategies need further investigation in large randomized trials. DCD donors have now evolved as a valid alternative to increase the potential donor pool and challenge the clinician with new questions. Optimal donor comfort therapy and end-of-life care are important to minimize the agonal phase. A strict approach towards the determination of death, based on cardiorespiratory criteria, is prerequisite. Novel strategies have been developed, using ex situ organ perfusion as a tool, to evaluate and recondition donor organs. They might become more important in the future to further optimize organ quality.

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