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Management of donation after brain death (DBD) in the ICU: the potential donor is identified, what's next?

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Abstract

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.

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Authors and Affiliations

  1. Donor Coordination Unit, Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, James’s St N, Ushers, Dublin, D03 VX82, Ireland

    Ignacio Martin-Loeches

  2. Donor Coordination Unit, Vall D’Hebron University Hospital, Barcelona, Spain

    Alberto Sandiumenge

  3. Medical Intensive Care Unit, Cochin Hospital, Paris, France

    Julien Charpentier

  4. University of Pittsburgh, Pittsburgh, PA, USA

    John A. Kellum

  5. Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland

    Alan M. Gaffney

  6. National Technical Transplant Council, Italian Health Institute, Rome, Italy

    Francesco Procaccio

  7. Brazilian Research in Intensive Care Network, BRICNet, São Paulo, Brazil

    Glauco A. Westphal

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  1. Ignacio Martin-Loeches
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  2. Alberto Sandiumenge
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  7. Glauco A. Westphal
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Correspondence to Ignacio Martin-Loeches.

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Martin-Loeches, I., Sandiumenge, A., Charpentier, J. et al. Management of donation after brain death (DBD) in the ICU: the potential donor is identified, what's next?. Intensive Care Med 45, 322–330 (2019). https://doi.org/10.1007/s00134-019-05574-5

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  • DOI: https://doi.org/10.1007/s00134-019-05574-5

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