Management of donation after brain death (DBD) in the ICU: the potential donor is identified, what's next?
The success of any donation process requires that potential brain-dead donors (PBDD) are detected and referred early to professionals responsible for their evaluation and conversion to actual donors. The intensivist plays a crucial role in organ donation. However, identification and referral of PBDDs may be suboptimal in the critical care environment. Factors influencing lower rates of detection and referral include the lack of specific training and the need to provide concomitant urgent care to other critically ill patients. Excellent communication between the ICU staff and the procurement organization is necessary to ensure the optimization of both the number and quality of organs transplanted. The organ donation process has been improved over the last two decades with the involvement and commitment of many healthcare professionals. Clinical protocols have been developed and implemented to better organize the multidisciplinary approach to organ donation. In this manuscript, we aim to highlight the main steps of organ donation, taking into account the following: early identification and evaluation of the PBDD with the use of checklists; donor management, including clinical maintenance of the PBDD with high-quality intensive care to prevent graft failure in recipients and strategies for optimizing donated organs by simplified care standards, clinical guidelines and alert tools; the key role of the intensivist in the donation process with the interaction between ICU professionals and transplant coordinators, nurse protocol managers, and communication skills training; and a final remark on the importance of the development of research with further insight into brain death pathophysiology and reversible organ damage.
KeywordsOrgan donation Transplantation Icu Critical care Brain death Early goal
Compliance with ethical standards
Conflicts of interest
No COIs to declare by any of the authors of the manuscript.
An ethical approval was not applicable.
- 3.Saidi RF, Hejazii Kenari SK (2014) Challenges of organ shortage for transplantation: solutions and opportunities. Int J organ Transpl Med 5:87–96Google Scholar
- 10.Malinoski DJ, Patel MS, Daly MC et al (2012) 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 40:2773–2780. https://doi.org/10.1097/CCM.0b013e31825b252a CrossRefGoogle Scholar
- 11.Patel MS, Zatarain J, De La Cruz S et al (2014) The impact of meeting donor management goals on the number of organs transplanted per expanded criteria donor: a prospective study from the UNOS region 5 donor management goals workgroup. JAMA Surg 149:969–975. https://doi.org/10.1001/jamasurg.2014.967 CrossRefGoogle Scholar
- 37.(2011) The Madrid resolution on organ donation and transplantation: national responsibility in meeting the needs of patients, guided by the WHO principles. Transplantation 91(Suppl 1):S29–S31. https://doi.org/10.1097/01.tp.0000399131.74618.a5