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Organ donation in adults: a critical care perspective

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Abstract

Purpose

The shortage of organs for transplantation is an important medical and societal problem because transplantation is often the best therapeutic option for end-stage organ failure.

Methods

We review the potential deceased organ donation pathways in adult ICU practice, i.e. donation after brain death (DBD) and controlled donation after circulatory death (cDCD), which follows the planned withdrawal of life-sustaining treatments (WLST) and subsequent confirmation of death using cardiorespiratory criteria.

Results

Strategies in the ICU to increase the number of organs available for transplantation are discussed. These include timely identification of the potential organ donor, optimization of the brain-dead donor by aggressive management of the physiological consequence of brain death, implementation of cDCD protocols, and the potential for ex vivo perfusion techniques.

Conclusions

Organ donation should be offered as a routine component of the end-of-life care plan of every patient dying in the ICU where appropriate, and intensivists are the key professional in this process.

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Author information

Author notes

    Authors and Affiliations

    1. School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy

      Giuseppe Citerio

    2. Neurointensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy

      Giuseppe Citerio

    3. Division of Thoracic Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada

      Marcelo Cypel

    4. Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia

      Geoff J. Dobb

    5. School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia

      Geoff J. Dobb

    6. Organización Nacional de Trasplantes, C/Sinesio Delgado 6, Pabellón 3, 28029, Madrid, Spain

      Beatriz Dominguez-Gil

    7. Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

      Jennifer A. Frontera

    8. Department of Neurology, Yale University School of Medicine, New Haven, CT, USA

      David M. Greer

    9. The Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK

      Alex R. Manara

    10. Division of Critical Care, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada

      Sam D. Shemie

    11. Department of Neurocritical Care, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK

      Martin Smith

    12. National Institute for Health Research UCLH Biomedical Research Centre, London, UK

      Martin Smith

    13. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

      Franco Valenza

    14. Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

      Eelco F. M. Wijdicks

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    1. Giuseppe Citerio
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    Correspondence to Giuseppe Citerio.

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    Additional information

    All the authors have contributed equally to this work.

    Take-home message: The shortage of organs for transplantation is an important medical and societal problem. Strategies in the ICU can increase the number of organ available for transplantation. These include: 1. optimizing the management of donors after brain death (DBD). 2. Implementing controlled DCD (cDCD). 3. Introducing a pathway for patients with devastating brain Injury (DBI).

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    Citerio, G., Cypel, M., Dobb, G.J. et al. Organ donation in adults: a critical care perspective. Intensive Care Med 42, 305–315 (2016). https://doi.org/10.1007/s00134-015-4191-5

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