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Intensive Care Medicine

, Volume 45, Issue 3, pp 322–330 | Cite as

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

  • Ignacio Martin-LoechesEmail author
  • Alberto Sandiumenge
  • Julien Charpentier
  • John A. Kellum
  • Alan M. Gaffney
  • Francesco Procaccio
  • Glauco A. Westphal
Review

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.

Keywords

Organ donation Transplantation Icu Critical care Brain death Early goal 

Notes

Compliance with ethical standards

Conflicts of interest

No COIs to declare by any of the authors of the manuscript.

Ethical approval

An ethical approval was not applicable.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Donor Coordination Unit, Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO)St James’s HospitalDublinIreland
  2. 2.Donor Coordination UnitVall D’Hebron University HospitalBarcelonaSpain
  3. 3.Medical Intensive Care UnitCochin HospitalParisFrance
  4. 4.University of PittsburghPittsburghUSA
  5. 5.Department of Anaesthesia and Critical CareBeaumont HospitalDublinIreland
  6. 6.National Technical Transplant Council, Italian Health InstituteRomeItaly
  7. 7.Brazilian Research in Intensive Care Network, BRICNetSão PauloBrazil

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