Skip to main content
SpringerLink
Log in

Organ Harvesting and the Role of Anesthesiologist

  • Chapter
  • First Online:
Anesthesiology

  • 3049 Accesses

Abstract

The ability to procure and allocate organs is dependent on patient comorbidities, logistical factors and ethical considerations. The anesthesia team plays a critical role in supporting organ donation which may include donation after brain death (DBD) or donation after cardiac death (DCD) procurements. Careful monitoring and management of the donor patient’s circulatory, respiratory, hematologic and endocrine parameters specific to organ donation type can improve transplant outcomes for the recipient.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
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

References

  1. http://optn.transplant.hrsa.gov.

  2. Wijdicks EFM, Varelas PN, Gronseth GS, et al. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:1911–8.

    Article  PubMed  Google Scholar 

  3. Bernat JL, D’lessandro AM, Port FK, et al. Report of a national conference on donation after cardiac death. Am J Transplant. 2006;6:281–91.

    Article  CAS  PubMed  Google Scholar 

  4. Campbell GM, Sutherland FR. Non-heart-beating organ donors as a source of kidneys for transplantation: a chart review. CMAJ. 1999;160:1573–6.

    PubMed  PubMed Central  CAS  Google Scholar 

  5. Klein AS, Messersmith EE, Ratner LE, et al. Organ donation and utilization in the United States, 1999–2008. Am J Transplant. 2010;10(Pt 2):973.

    Article  CAS  PubMed  Google Scholar 

  6. Kowalski AE, Light JA, Ritchie WO, Sasaki TM, Callender CO, Gage F. A new approach for increasing the organ supply. Clin Transpl. 1996;10:653–7.

    CAS  Google Scholar 

  7. 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;304:2620–7.

    Article  CAS  PubMed  Google Scholar 

  8. Pennefather SH, Bullock RE, Dark JH. The effect of fluid therapy on alveolar arterial oxygen gradient in brain-dead organ donors. Transplantation. 1993;56:1418–21.

    Article  CAS  PubMed  Google Scholar 

  9. Martin J, Lutter G, Ihling C, et al. Myocardial viability twenty-four hours after orthotopic heart transplantation from non-heart-beating donors. J Thorac Cardiovasc Surg. 2003;125:1217–28.

    Article  PubMed  Google Scholar 

  10. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining death: a report on the medical, legal, and ethical issues in the determination of death. Washington, DC: Government Printing Office; 1981.

    Google Scholar 

  11. Barclay WR. Guidelines for the determination of death. JAMA. 1981;246(19):2194. https://doi.org/10.1001/jama.1981.03320190052031.

    Article  PubMed  Google Scholar 

  12. Wijdicks EFM. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology. 2002;58:20–5.

    Article  PubMed  Google Scholar 

  13. 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  PubMed  Google Scholar 

  14. Belzberg H, Shoemaker WC, Wo CC, et al. Hemodynamic and oxygen transport patterns after head trauma and brain death: implications for management of the organ donor. J Trauma. 2007;63:1032–42.

    Article  PubMed  Google Scholar 

  15. Szabo G. Physiologic changes after brain death. J Heart Lung Transplant. 2004;23(9 Suppl):S223–6.

    Article  PubMed  Google Scholar 

  16. Plurad DS, Bricker S, Neville A, Bongard F, Putnam B. Arginine vasopressin significantly increases the rate of successful organ procurement in potential donors. Am J Surg. 2012;204:856–60.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  18. Rosengard BR, Feng S, Alfrey EJ, et al. Report of the Crystal City meeting to maximize the use of organs recovered from the cadaver donor. Am J Transplant. 2002;2:701–11.

    Article  PubMed  Google Scholar 

  19. Cittanova ML, Leblanc I, Legendre C, Mouquet C, Riou B, Coriat P. Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients. Lancet. 1996;348:1620–2.

    Article  CAS  PubMed  Google Scholar 

  20. Blasco V, Leone M, Antonini F, Geissler A, Albanese 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;100:504–8.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  22. Shemie SD, Ross H, Pagliarello J, et al. Organ donor management in Canada: recommendations of the forum on medical management to optimize donor organ potential. CMAJ. 2006;174:S13–32.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 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;56:738–46.

    Article  CAS  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Gelb AW, Robertson KM. Anaesthetic management of the brain dead for organ donation. Can J Anaesth. 1990;37:806–12.

    Article  CAS  PubMed  Google Scholar 

  26. McKeown DW, Bonser RS, Kellum JA. Management of the heartbeating brain-dead organ donor. Br J Anaesth. 2012;108(Suppl 1):i96–107.

    Article  PubMed  Google Scholar 

  27. Dictus C, Vienenkoetter B, Esmaeilzadeh M, Unterberg A, Ahmadi R. Critical care management of potential organ donors: our current standard. Clin Transpl. 2009;23(Suppl 21):2–9.

    Article  Google Scholar 

  28. Wood KE, Becker BN, McCartney JG, D’Alessandro AM, Coursin DB. Care of the potential organ donor. N Engl J Med. 2004;351:2730–9.

    Article  CAS  PubMed  Google Scholar 

  29. Rosendale JD, Kauffman HM, McBride MA, et al. Aggressive pharmacological donor management results in more transplanted organs. Transplantation. 2003;75:482–7.

    Article  PubMed  Google Scholar 

  30. Lucangelo U, Del Sorbo L, Boffini M, Ranieri VM. Protective ventilation for lung transplantation. Curr Opin Anesthesiol. 2012;25(2):170–4.

    Article  Google Scholar 

  31. Cortjens B, Royakkers AA, Determann RM, et al. Lung-protective mechanical ventilation does not protect against acute kidney injury in patients without lung injury at onset of mechanical ventilation. J Crit Care. 2011;27(3):261–7.

    Article  PubMed  Google Scholar 

  32. Rampil IJ. Anesthetic potency is not altered after hypothermic spinal cord transection in rats. Anesthesiology. 1994;80:606–10.

    Article  CAS  PubMed  Google Scholar 

  33. Yoo KY, Jeong CW, Kim SJ, et al. Sevoflurane concentrations required to block autonomic hyperreflexia during transurethral litholapaxy in patients with complete spinal cord injury. Anesthesiology. 2008;108(5):858–63.

    Article  CAS  PubMed  Google Scholar 

  34. De Hert SG, Turani F, Mathur S, Stowe DF. Cardioprotection with volatile anesthetics: mechanisms and clinical implications. Anesth Analg. 2005;100(6):1584–93.

    Article  PubMed  Google Scholar 

  35. Arbour R. Clinical management of the organ donor. AACN Clin Issues. 2005;16(4):551–80.

    Article  PubMed  Google Scholar 

  36. 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  PubMed  Google Scholar 

  37. Nijboer WN, Schuurs TA, van der Hoeven JA, et al. Effect of brain death on gene expression and tissue activation in human donor kidneys. Transplantation. 2004;78(7):978–86.

    Article  PubMed  Google Scholar 

  38. Kaminska D, Tyran B, Mazanowska O, et al. Cytokine gene expression in kidney allograft biopsies after donor brain death and ischemia-reperfusion injury using in situ reverse-transcription polymerase chain reaction analysis. Transplantation. 2007;84(9):1118–24.

    Article  CAS  PubMed  Google Scholar 

  39. Sánchez-Fructuoso AI, Prats D, Marques M, et al. Does donor brain death influence acute vascular rejection in the kidney transplant? Transplantation. 2004;78(1):142–6.

    Article  PubMed  Google Scholar 

  40. Antognini JF, Berg K. Cardiovascular responses to noxious stimuli during isoflurane anesthesia are minimally affected by anesthetic action in the brain. Anesth Analg. 1995;81(4):843–8.

    PubMed  CAS  Google Scholar 

  41. Du Pont-Thibodeau G, Harrington K, Lacroix J. Anemia and red blood cell transfusion in critically ill cardiac patients. Ann Intensive Care. 2014;4:16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Van Bakel AB. The cardiac transplant donor: identification, assessment, and management. Am J Med Sci. 1997;314(3):152–63.

    Google Scholar 

  43. Zaroff JG, Rosengard BR, Armstrong WF, Babcock WD, D’Alessandro A, Dec GW, Edwards NM, Higgins RS, Jeevanandum V, Kauffman M, Kirklin JK, Large SR, Marelli D, Peterson TS, Ring WS, Robbins RC, Russell SD, Taylor DO, Van Bakel A, Wallwork J, Young JB. Consensus conference report maximizing use of organs recovered from the cadaver donor: cardiac recommendations. Circulation. 2002;106:836–41.

    Article  PubMed  Google Scholar 

  44. Talving P, Benfield R, Hadjizacharia P, Inaba K, Chan LS, Demetriades D. Coagulopathy in severe traumatic brain injury: a prospective study. J Trauma. 2009;66:55–61; discussion 61–2

    Article  PubMed  Google Scholar 

  45. de Oliveira Manoel AL, Neto AC, Veigas PV, Rizoli S. Traumatic brain injury associated coagulopathy. Neurocrit Care. 2014;22(1):34–44. https://doi.org/10.1007/s12028-014-0026-4.

    Article  Google Scholar 

  46. Hefty TR, Cotterell LW, Fraser SC, Goodnight SH, Hatch TR. Disseminated intravascular coagulation in cadaveric organ donors: incidence and effect on renal transplantation. Transplantation. 1993;55:442–3.

    Article  CAS  PubMed  Google Scholar 

  47. Mannucci PM, Levi M. Prevention and treatment of major blood loss. N Engl J Med. 2007;356:2301–11. https://doi.org/10.1056/NEJMra067742.

    Article  PubMed  CAS  Google Scholar 

  48. Brown JE, Olujohungbe A, Chang J, Ryder WD, Morganstern GR, Chopra R, Scarffe JH. All-trans retinoic acid (ATRA) and tranexamic acid: a potentially fatal combination in acute promyelocytic leukaemia. Br J Haematol. 2000;110:1010–2. https://doi.org/10.1046/j.1365-2141.2000.02270-8.x.

    Article  PubMed  CAS  Google Scholar 

  49. de la Serna J, Montesinos P, Vellenga E, Rayon C, Parody R, Leon A, Esteve J, Bergua JM, Milone G, Deben G, Rivas C, Gonzalez M, Tormo M, az-Mediavilla J, Gonzalez JD, Negri S, Amutio E, Brunet S, Lowenberg B, Sanz MA. Causes and prognostic factors of remission induction failure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and idarubicin. Blood. 2008;111:3395–402. https://doi.org/10.1182/blood-2007-07-100669.

    Article  PubMed  CAS  Google Scholar 

  50. Walsh M, Thomas SG, Howard JC, Evans E, Guyer K, Medvecz A, et al. Blood component therapy in trauma guided with the utilization of the perfusionist and thromboelastography. J Extra Corpor Technol. 2011;43:162–7.

    PubMed  PubMed Central  Google Scholar 

  51. Novitzky D, Cooper DK, Reichart B. Hemodynamic and metabolic responses to hormonal therapy in brain-dead potential organ donors. Transplantation. 1987;43:852–4.

    Article  CAS  PubMed  Google Scholar 

  52. Howlett TA, Keogh AM, Perry L, Touzel R, Rees LH. Anterior and posterior pituitary function in brain-stem-dead donors. Transplantation. 1989;47:828–34.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  54. Novitzky D, Cooper DK, Rosendale JD, Kauffman HM. Hormonal therapy of the brain-dead organ donor: experimental and clinical studies. Transplantation. 2006;82(11):1396–401.

    Article  CAS  PubMed  Google Scholar 

  55. Dhar R, Cotton C, Coleman J, et al. Comparison of high- and low-dose corticosteroid regimens for organ donor management. J Crit Care. 2013;28:111.e1–7.

    Article  CAS  Google Scholar 

  56. Masson F, Thicoipe M, Gin H, De Mascarel A, Angibeau RM, Favarel-Garrigues JF, et al. The endocrine pancreas in brain-dead donors. Transplantation. 1993;56(2):363–7.

    Article  CAS  PubMed  Google Scholar 

  57. Nunnally ME, O’Connor MF. Glycemic control for organs: a new approach to a controversial topic. J Cardiothorac Vasc Anesth. 2005;19:689–90.

    Article  PubMed  Google Scholar 

  58. University of Pittsburgh. MOnIToR Study. https://crisma.upmc.com/MonitorStudy/index.asp. Accessed Jan 2015.

  59. Blasi-Ibanez A, Hirose R, Feiner J, Freise C, Stock P, Roberts JP, Niemann CU. Predictors associated with terminal renal function in deceased organ donors in the intensive care unit. Anesthesiology. 2009;110:333–41.

    PubMed  Google Scholar 

  60. Sally MB, Ewing T, Crutchfield M, et al. Determining optimal threshold for glucose control in organ donors after neurologic determination of death: a United Network for Organ Sharing Region 5 Donor Management Goals Workgroup prospective analysis. J Trauma Acute Care Surg. 2014;76:62–8; discussion 68–9

    Article  CAS  PubMed  Google Scholar 

  61. Malinoski DJ, Patel MS, Daly MC, Oley-Graybill C, Salim A, UNOS Region 5 DMG Workgroup. The impact of meeting donor management goals on the number of organs transplanted per donor: results from the United Network for Organ Sharing Region 5 prospective donor management goals study. Crit Care Med. 2012;40:2773–80.

    Article  PubMed  Google Scholar 

  62. Totsuka E, Dodson F, Urakami A, et al. Influence of high donor serum sodium levels on early postoperative graft function in human liver transplantation: effect of correction of donor hypernatremia. Liver Transpl Surg. 1999;5:421–8.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  64. Rosendale JD, Kauffman HM, McBride MA, et al. Hormonal resuscitation yields more transplanted hearts, with improved early function. Transplantation. 2003;75:1336–41.

    Article  PubMed  Google Scholar 

  65. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172–8. https://doi.org/10.1378/chest.07-2331.

    Article  PubMed  Google Scholar 

  66. Michard F. Changes in arterial pressure during mechanical ventilation. Anesthesiology. 2005;103:419–28.

    Article  PubMed  Google Scholar 

  67. Bakkar J, Nijsten M, Jansen T. Clinical use of lactate monitoring in critically ill patients. Ann Intensive Care. 2013;3:12.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Cooper Medical School of Rowan University/Cooper University Health Care, Camden, NJ, USA

    Michael R. Schwartz M.D. & Erin W. Pukenas M.D., F.A.A.P., C.P.P.S.

Authors
  1. Michael R. Schwartz M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erin W. Pukenas M.D., F.A.A.P., C.P.P.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael R. Schwartz M.D. .

Editor information

Editors and Affiliations

  1. Hospital University Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA

    Basavana G. Goudra

  2. Department of Anesthesiology, Emory University, Atlanta, Georgia, USA

    Michael Duggan

  3. Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

    Vidya Chidambaran

  4. University Hospitals Birmingham, Birmingham, United Kingdom

    Hari Prasad Krovvidi Venkata

  5. Emory University Hospital, Atlanta, Georgia, USA

    Elizabeth Duggan

  6. University of Alabama at Birmingham, Birmingham, Alabama, USA

    Mark Powell

  7. All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India

    Preet Mohinder Singh

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Schwartz, M.R., Pukenas, E.W. (2018). Organ Harvesting and the Role of Anesthesiologist. In: Goudra, B., et al. Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-74766-8_77

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74766-8_77

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74765-1

  • Online ISBN: 978-3-319-74766-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation