Skip to main content
SpringerLink
Log in

Neuroanesthesia and Brain Death

  • Chapter
  • First Online:
Co-existing Diseases and Neuroanesthesia

  • 535 Accesses

Abstract

The pathophysiological changes that occur after the brain death provoke a severe derangement of the cardiocirculatory, respiratory, endocrine, and metabolic systems that lead to the impair of all the organs’ function and the cardiac arrest. Brain-dead patients might be considered as potential organ donors for transplantation, but all the changes that the organism undergoes once it is dead can make this possibility difficult if we are not able to control them. An adequate knowledge of the pathophysiology related to brain death is essential to adopt all the necessary medical measures so that this potential donor can reach the operating room and organ retrieval can be performed in the best possible conditions which would allow a safe transplantation to the recipients. The development of clinical management protocols and the professionalization of the medical teams dealing with this situation are key for the success of transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Power BM, Van Heerden PV. The physiological changes associated with brain death-current concepts and implications for treatment of the brain dead organ donor. Anaesth Intensive Care. 1995;23(1):26–36.

    CAS  PubMed  Google Scholar 

  2. Valero R. Donor management: one step forward. Am J Transplant. 2002;2(8):693–4.

    Article  Google Scholar 

  3. Mascia L, Mastromauro I, Viberti S, Vincenzi M, Zanello M. Management to optimize organ procurement in brain dead donors. Minerva Anestesia. 2009;75:125–33.

    CAS  Google Scholar 

  4. Venkateswaran RV, Patchell VB, Wilson IC, et al. Early donor management increases the retrieval rate of lungs for transplantation. Ann Thorac Surg. 2008;85(1):278–86.

    Article  Google Scholar 

  5. Cantin B, Kwok BW, Chan MC, et al. The impact of brain death on survival after heart transplantation: time is of the essence. Transplantation. 2003;76(9):1275–9.

    Article  Google Scholar 

  6. Abdelnour T, Rieke S. Relationship of hormonal resuscitation therapy and central venous pressure on increasing organs for transplant. J Heart Lung Transplant. 2009;28(5):480–5.

    Article  Google Scholar 

  7. Avlonitis VS, Wigfield CH, Golledge HD, Kirby JA, Dark JH. Early hemodynamic injury during donor brain death determines the severity of primary graft dysfunction after lung transplantation. Am J Transplant. 2007;7(1):83–90.

    Article  CAS  Google Scholar 

  8. Wheeldon DR, Potter CD, Oduro A, Wallwork J, Large SR. Transforming the “unacceptable” donor: outcomes from the adoption of a standardized donor management technique. J Heart Lung Transplant. 1995;14(4):734–42.

    CAS  Google Scholar 

  9. Salim A, Martin M, Brown C, Rhee P, Demetriades D, Belzberg H. The effect of a protocol of aggressive donor management: implications for the national organ donor shortage. J Trauma. 2006;61(2):429–33.

    Article  Google Scholar 

  10. Jenkins DH, Reilly PM, Schwab CW. Improving the approach to organ donation: a review. World J Surg. 1999;23(7):644–9.

    Article  CAS  Google Scholar 

  11. Shemie SD, Doig C, Dickens B, et al. Severe brain injury to neurological determination of death: Canadian forum recommendations. CMAJ. 2006;174(6):S1–13.

    Article  Google Scholar 

  12. Rosendale JD, Chabalewski FL, McBride MA, et al. Increased transplanted organs from the use of a standardized donor management protocol. Am J Transplant. 2002;2(8):761–8.

    Article  Google Scholar 

  13. Lopez-Navidad A, Domingo P, Caballero F. Organ shortage: viability of potential organ donors and possible loss depend on health care workers who are responsible for the organ procurement program. Transplant Proc. 1997;29(8):3614–6.

    Article  CAS  Google Scholar 

  14. Singbartl K, Murugan R, Kaynar AM, et al. Intensivist-led management of brain-dead donors is associated with an increase in organ recovery for transplantation. Am J Transplant. 2011;11(7):1517–21.

    Article  CAS  Google Scholar 

  15. Wood RF. Donor management, multi organ procurement and renal preservation. J R Soc Med. 1996;89(Suppl 29):23–4.

    PubMed  PubMed Central  Google Scholar 

  16. Avlonitis VS, Wigfield CH, Kirby JA, Dark JH. The hemodynamic mechanisms of lung injury and systemic inflammatory response following brain death in the transplant donor. Am J Transplant. 2005;5(4 Pt 1):684–93.

    Article  Google Scholar 

  17. Wood KE, Becker BN, McCartney JG, D’Alessandro AM. CoursinDB. Care of the potential organ donor. N Engl J Med. 2004;351(26):2730–9.

    Article  CAS  Google Scholar 

  18. Salim A, Martin M, Brown C, Belzberg H, Rhee P, Demetriades D. Complications of brain death: frequency and impact on organ retrieval. Am Surg. 2006;72(5):377–81.

    PubMed  Google Scholar 

  19. Boom H, Mallat MJ, de Fijter JW, Paul LC, Bruijn JA, van Es LA. Calcium levels as a risk factor for delayed graft function. Transplantation. 2004;77(6):868–73.

    Article  CAS  Google Scholar 

  20. Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013;41(7):1774–81.

    Article  Google Scholar 

  21. Cywinski JB, Mascha E, Miller C, et al. Association between donor- recipient serum sodium differences and orthotopic liver transplant graft function. Liver Transpl. 2008;14(1):59–65.

    Article  Google Scholar 

  22. Blasco V, Leone M, Antonini F, Geissler A, Albanèse J, Martin C. Comparison of the novel hydroxyethylstarch 130/0.4 and hydroxyethylstarch 200/0.6 in brain-dead donor resuscitation on renal function after transplantation. Br J Anaesth. 2008;100(4):504–8.

    Article  CAS  Google Scholar 

  23. Zarychanski R, Abou-Setta AM, Turgeon AF, et al. Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA. 2013;309(7):678–88.

    Article  CAS  Google Scholar 

  24. Grissom TE, Richards JE, Herr DL. Critical care management of the potential organ donor. Int Anesthesiol Clin. 2017;55(2):18–41.

    Article  Google Scholar 

  25. Kotloff RM, Blosser S, Fulda GJ, et al. Management of the potential organ donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement. Crit Care Med. 2015;43:1291–325.

    Article  Google Scholar 

  26. Schnuelle P, Lorenz D, Mueller A, Trede M, van der Woude FJ. Donor catecholamine use reduces acute allograft rejection and improves graft survival after cadaveric renal transplantation. Kidney Int. 1999;56(2):738–46.

    Article  CAS  Google Scholar 

  27. Schnuelle P, Berger S, de BJ, Persijn G, van der Woude FJ. Effects of catecholamine application to brain-dead donors on graft survival in solid organ transplantation. Transplantation. 2001;72(3):455–63.

    Article  CAS  Google Scholar 

  28. Schnuelle P, Berger S, de BJ, Persijn G, van der Woude FJ. Donor employment of vasopressors and its impact on allograft survival after transplantation. Transplant Proc. 2001;33(1-2):1282–3.

    Article  CAS  Google Scholar 

  29. Schnuelle P, Yard BA, Braun C, et al. Impact of donor dopamine on immediate graft function after kidney transplantation. Am J Transplant. 2004;4(3):419–26.

    Article  CAS  Google Scholar 

  30. Schnuelle P, Gottmann U, Hoeger S, et al. Effects of donor pretreatment with dopamine on graft function after kidney transplantation: a randomized controlled trial. JAMA. 2009;302(10):1067–75.

    Article  CAS  Google Scholar 

  31. Stoica SC, Satchithananda DK, White PA, Parameshwar J, Redington AN, Large SR. Noradrenalin use in the human donor and relationship with load-independent right ventricular contractility. Transplantation. 2004;78(8):1193–7.

    Article  CAS  Google Scholar 

  32. Pennefather SH, Bullock RE, Mantle D, Dark JH. Use of low dose arginine vasopressin to support brain-dead organ donors. Transplantation. 1995;59(1):58–62.

    Article  CAS  Google Scholar 

  33. de Perrot M, Weder W, Patterson GA, Keshavjee S. Strategies to increase limited donor resources. Eur Respir J. 2004;23(3):477–82.

    Article  Google Scholar 

  34. Venkateswaran RV, Steeds RP, Quinn DW, et al. The haemodynamic effects of adjunctive hormone therapy in potential heart donors: a prospective randomized double-blind factorially designed controlled trial. Eur Heart J. 2009;30(14):1771–80.

    Article  CAS  Google Scholar 

  35. Chamorro-Jambrina C, Muñoz-Ramírez MR, Martínez-Melgar JL, Pérez-Cornejo MS. Organ donor management: eight common recommendations and actions that deserve reflection. Med Intensiva. 2017;41(9):559–68.

    Article  CAS  Google Scholar 

  36. Busl KM, Bleck TP. Neurogenic pulmonary edema. Crit Care Med. 2015;43:1710–5.

    Article  Google Scholar 

  37. McLean KM, Pandalai PK, Pearl JM, et al. Beta-adrenergic receptor antagonism preserves myocardial function after brain death in a porcine model. J Heart Lung Transplant. 2007;26(5):522–8.

    Article  Google Scholar 

  38. Audibert G, Charpentier C, Seguin-Devaux C, et al. Improvement of donor myocardial function after treatment of autonomic storm during brain death. Transplantation. 2006;82(8):1031–6.

    Article  CAS  Google Scholar 

  39. Powner DJ, Crommett JW. Advanced assessment of hemodynamic parameters during donor care. Prog Transplant. 2003;13(4):249–57.

    Article  Google Scholar 

  40. Gu J, Tao G, Yi B, et al. Hemodynamic monitoring in pigs undergoing orthotopic abdominal multivisceral transplantation. Transplant Proc. 2009;41(10):4376–81.

    Article  CAS  Google Scholar 

  41. Dominguez-Roldan JM, Jimenez-Gonzalez PI, Garcia-Alfaro C, Hernandez-Hazanas F, Fernandez-Hinojosa E, Bellido-Sanchez R. Electrolytic disorders, hyperosmolar states, and lactic acidosis in braindead patients. Transplant Proc. 2005;37(5):1987–9.

    Article  CAS  Google Scholar 

  42. Powner DJ, Allison TA. Cardiac dysrhythmias during donor care. Prog Transplant. 2006;16(1):74–80.

    Article  Google Scholar 

  43. Nolan JP, Deakin CD, Soar J, Bottiger BW, Smith G. European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation. 2005;67(Suppl 1):S39–86.

    Article  Google Scholar 

  44. Rech TH, Moraes RB, Crispim D, Czepielewski MA, Leitão CB. Management of the brain-dead organ donor: a systematic review and meta-analysis. Transplantation. 2013;95(7):966–74.

    Article  Google Scholar 

  45. Garcia-Fages LC, Cabrer C, Valero R, Manyalich M. Hemodynamic and metabolic effects of substitutive triiodothyronine therapy in organ donors. Transplant Proc. 1993;25(6):3038–9.

    CAS  PubMed  Google Scholar 

  46. Novitzky D, Cooper DK, Human PA, Reichart B, Zuhdi N. Triiodothyronine therapy for heart donor and recipient. J Heart Transplant. 1988;7(5):370–6.

    CAS  PubMed  Google Scholar 

  47. Novitzky D, Cooper DK, Chaffin JS, Greer AE, DeBault LE, Zuhdi N. Improved cardiac allograft function following triiodothyronine therapy to both donor and recipient. Transplantation. 1990;49(2):311–6.

    Article  CAS  Google Scholar 

  48. Rosendale JD, Kauffman HM, McBride MA, et al. Aggressive pharmacologic donor management results in more transplanted organs. Transplantation. 2003;75(4):482–7.

    Article  Google Scholar 

  49. Novitzky D, Mi Z, Videla LA, Collins JF, Cooper DK. Hormone resuscitation therapy for brain-dead donors - is insulin beneficial or detrimental? Clin Transplant. 2016;30(7):754–9.

    Article  CAS  Google Scholar 

  50. Salim A, Martin M, Brown C, et al. Using thyroid hormone in brain- dead donors to maximize the number of organs available for transplantation. Clin Transplant. 2007;21(3):405–9.

    Article  Google Scholar 

  51. Dimopoulou I, Tsagarakis S, Anthi A, et al. High prevalence of decreased cortisol reserve in brain-dead potential organ donors. Crit Care Med. 2003;31(4):1113–7.

    Article  CAS  Google Scholar 

  52. Blasi-Ibañez A, Hirose R, Feiner J, et al. Predictors associated with terminal renal function in deceased organ donors in the intensive care unit. Anesthesiology. 2009;110(2):333–41.

    PubMed  Google Scholar 

  53. Obermaier R, von DE, Keck T, et al. Brain death impairs pancreatic microcirculation. Am J Transplant. 2004;4(2):210–5.

    Article  Google Scholar 

  54. Mascia L, Bosma K, Pasero D, et al. Ventilatory and hemodynamic management of potential organ donors: an observational survey. Crit Care Med. 2006;34(2):321–7.

    Article  Google Scholar 

  55. Avlonitis VS, Fisher AJ, Kirby JA, Dark JH. Pulmonary transplantation: the role of brain death in donor lung injury. Transplantation. 2003;75(12):1928–33.

    Article  Google Scholar 

  56. Powner DJ, Darby JM, Stuart SA. Recommendations for mechanical ventilation during donor care. Prog Transplant. 2000;10(1):33–8.

    Article  CAS  Google Scholar 

  57. Gabbay E, Williams TJ, Griffiths AP, et al. Maximizing the utilization of donor organs offered for lung transplantation. Am J Respir Crit Care Med. 1999;160(1):265–71.

    Article  CAS  Google Scholar 

  58. Mascia L, Pasero D, Slutsky AS, et al. Effect of a lung protective strategy for organ donors on eligibility and availability of lungs for transplantation: a randomized controlled trial. JAMA. 2010;304(23):2620–7.

    Article  CAS  Google Scholar 

  59. Follette DM, Rudich SM, Babcock WD. Improved oxygenation and increased lung donor recovery with high-dose steroid administration after brain death. J Heart Lung Transplant. 1998;17(4):423–9.

    CAS  PubMed  Google Scholar 

  60. Powner DJ, Reich HS. Regulation of coagulation abnormalities and temperature in organ donors. Prog Transplant. 2000;10(3):146–51. quiz 152-3

    Article  CAS  Google Scholar 

  61. Del Río F, Escudero D, De la Calle B, Gordo Vidal F, Valentín Paredes M, Ramón Núñez J. Evaluación y mantenimiento del donante pulmonar. Med Intensiva. 2009;33(1):40–9.

    Article  Google Scholar 

  62. Hergenroeder GW, Ward NH, Yu X, et al. Randomized trial to evaluate nutritional status and absorption of enteral feeding after brain death. Prog Transpl. 2013;23:374–82.

    Article  Google Scholar 

  63. Singer P, Cohen J, Cynober L. Effect of nutritional state of brain- dead organ donor on transplantation. Nutrition. 2001;17(11-12):948–52.

    Article  CAS  Google Scholar 

  64. Barklin A. Systemic inflammation in the brain-dead organ donor. Acta Anaesthesiol Scand. 2009;53(4):425–35.

    Article  CAS  Google Scholar 

  65. Nijboer WN, Schuurs TA, van der Hoeven JA, et al. Effects of brain death on stress and inflammatory response in the human donor kidney. Transplant Proc. 2005;37(1):367–9.

    Article  CAS  Google Scholar 

  66. Kuecuek O, Mantouvalou L, Klemz R, et al. Significant reduction of proinflammatory cytokines by treatment of the brain-dead donor. Transplant Proc. 2005;37(1):387–8.

    Article  CAS  Google Scholar 

  67. Kotsch K, Ulrich F, Reutzel-Selke A, et al. Methylprednisolone therapy in deceased donors reduces inflammation in the donor liver and improves outcome after liver transplantation: a prospective randomized controlled trial. Ann Surg. 2008;248(6):1042–50. Erratum in: Ann Surg 2011; 254(2): 391

    Article  Google Scholar 

  68. Venkateswaran V, Dronavalli V, et al. Proinflammatory environment in potential heart and lung donors: prevalence and impact of donor management and hormonal therapy. Transplantation. 2009;88(4):582–8.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain

    Ramón Adalia

  2. Hospital Clínic de Barcelona, Barcelona, Spain

    Paola Hurtado

  3. Hospital Clínic de Barcelona, TPM-DTI Foundation, Universitat de Barcelona, Barcelona, Spain

    Ricard Valero

Authors
  1. Ramón Adalia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paola Hurtado
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ricard Valero
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ricard Valero .

Editor information

Editors and Affiliations

  1. Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India

    Hemanshu Prabhakar

  2. Department of Neuroanesthesiology and Neurocritical Care, Medanta, The Medicity, Gurugram, India

    Vasudha Singhal

  3. Department of Neuroanaesthesia, Indraprastha Apollo Hospital, New Delhi, India

    Nidhi Gupta

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Adalia, R., Hurtado, P., Valero, R. (2019). Neuroanesthesia and Brain Death. In: Prabhakar, H., Singhal, V., Gupta, N. (eds) Co-existing Diseases and Neuroanesthesia. Springer, Singapore. https://doi.org/10.1007/978-981-13-2086-6_15

Download citation

  • DOI: https://doi.org/10.1007/978-981-13-2086-6_15

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-2085-9

  • Online ISBN: 978-981-13-2086-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation