Organ Donor maintainence Organ Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainenceOrgan Donor maintainence

1. Dr Abdul Samad Ansari
Director, Critical care unit
Nanavati Max Super Speciality
Deceased Donor Maintenance

2. OVERVIEW
• Brainstem Death Definitions
• Physiological Abnormalities
• Optimization Of Physiological Systems
• Key Priorities

4. Complete and irreversible cessation of brain
activity including the brain stem.
Absence of apparent brain function is not enough
Evidence of irreversibilty is also required
First country to adopt brain death as a legal
definition of
death was Finland in 1971
DEFINITION

6. OBJECTIVE
• Management is directed towards themaintenance of
• physiological homeostasis to optimize organ function and maximize graft
viability in the organ recipient.

7. NEED FOR OPTIMISATION

8. CARDIOVASCULAR
•Increased ICP-cushings reflex (increase in arterial blood pressure and
cardiac afterload, left atrial pressure elevation, increased pressure in the pulmonary
capillary bed, pulmonary vasoconstriction, and endothelial damage)
•Release of catecholamines-myocardial depression
•Spinal cord ischaemia-hypotension
•Myocardial ischaemia
Physiological
Changes

10. RESPIRATORY
•Catecholamine storm-neurogenic pulmonary oedema
•Release of pro-inflammatory mediators-lung injury
•Lung dysfunction –trauma, atelectasis, aspiration
•Deep sedation and paralysis for ICP Management

11. RENA
L
•Elevated renal tubular injury biomarkers
ENDOCRINE
•Pituitary ischaemia-anterior and posterior pituitary dysfunction
-DI-polyuria,hypovolemic shock,hypernatremia
•Peripheral endocrine effects-
•hyperglycemia,sick euthyroid syndrome
HEMATOLOGICAL
•Plasminogen activator-DIC (an increased fibrin formation, hypofbrinolysis, higher platelet activation,
dysregulation in the vonWillebrand factor production (which promotes platelet attachment to damaged
vasculature),

13.  Hypothermia
 Hypotension(81-97%)
 Diabetes insipidus(46-78%)
 DIC(29-55%)
 Cardiac arrythmias (25-32%)
 Pulmonary edema(13-18%)
Management is directed towards maintenance of physiological
homeostasis
Summary of Physiological Changes

20. Management of Hemodynamic:
• 1)Managing Hypertension: Because of the transient nature of autonomic
storm, antihypertensive are usually not required.
• If needed, short acting antihypertensive such as esmolol, sodium
nitroprusside, hydralazine, labetalol, or nitroglycerine should be used.

21. Treating Hypovolemia:
A) Volume Expansion: Crystalloids with balanced salt content so as to avoid
hypernatremia and hyperchloraemic acidosis Avoid colloids
B) Vasopressors, Inotropes:Vasopressin in pressor dose (1-2 U/hr.) plays an
important role in stabilizing the hemodynamic of brain-dead patient
C) Hormonal Replacement: No clear recommendations regardingT3
administration
• Thyroxine300-400mcg through Nash-gastric route can be given in
hemodynamic ally unstable patients, but absorption and clinical effect is
not proven

23. Lung protective ventilation
strategies
lowest possible plateau
pressure,
TV-6ml/kg,
PEEP-5-10,
sat>92-95%
Recruitment
Elevation of Head End
Respiratory Management

24.  Thyroid hormone-Routine replacement not advocated
 Corticosteroids-recommended ,
not to treat adrenocortical failure but to attenuate immune
responses and reduce catecholamine requirement for BP
maintenance
Insulin-hyperglycemia is common which causes reduced host
immune response,increased risk of infection,osmotic diuresis.
 ADH- DI
 Combination therapy-Thyroid,Steroid,Vasopressin
Endocrine Management

27. Infection Management
• • Donor should be infection free.
• • Routine use of antibiotic prophylaxis is not warranted
• • Use of antibiotic agents on the basis of results of Gram’s staining of aspirated
secretion and positive cultures.

28. Management of Nutrition
• • Nutrition should be continued as per standard ICU protocol
• • Nutrition should be continued in patients awaiting consent for organ
donation from the caregivers.
• • Continuing enteral feeding in the potential donors may help in providing
beneficial effects for organ functioning

29. Malignancy
Positive HIV, hepatitis
serology
Age>70 years
Contraindications For Organ Donation
Absolute/Relative

30. Key Priorities

31. ABC
approach