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Gestion du donneur d’organes pédiatrique

Management of paediatric organ donor

  • Enseignement Supérieur en Réanimation Pédiatrique
  • Published:
Réanimation

Résumé

Les greffes pédiatriques souffrent d’une pénurie d’organes que compensent insuffisamment les priorités d’attribution, en particulier chez le petit enfant. Le prélèvement d’organes pédiatrique doit être valorisé par une optimisation de la prise en charge des enfants donneurs potentiels et de leur famille. Le diagnostic de la mort encéphalique est clinique dans un contexte étiologique compatible, et son irréversibilité nécessite d’être confirmée soit par deux électroencéphalogrammes nuls et aréactifs, réalisés selon des critères stricts, soit par une angiographie cérébrale. En réponse à l’arrêt des fonctions neurovégétatives centrales, le traitement neuroprotecteur cède alors la place à la réanimation systémique qui optimise en priorité l’état hémodynamique général et la fonction des greffons potentiels. Une connaissance rigoureuse sur le diagnostic de la mort encéphalique pédiatrique et une réflexion consensuelle sur la réanimation systémique de ces petits donneurs de greffons sont indispensables pour favoriser l’implication de toute une équipe de soins et participer humainement avec la coordination à l’approche de parents anéantis et oser rechercher leur consentement au don.

Abstract

Paediatric transplantation suffers from a real shortage of compatible organs which is not compensated by attribution priorities, particularly in the case of small children. Paediatric organ recovery should be given more importance by optimizing the intensive care of potential organ donors and family counselling. Brain death is a clinical diagnosis made in the presence of complete and irreversible cessation of all brain functions, after identification of a compatible aetiology. The irreversible status of brain death can be confirmed by two isoelectric and non-reactive electroencephalograms, performed in strict conditions or based on cerebral angiography. Once brain death is confirmed, intensive care aims maintaining haemodynamic parameters, to protect organs instead of brain function. Procedures leading to the diagnosis of brain death in children as well as systemic intensive management of small donors should be well-known and accepted by each member of the caring team. This strategy aims at allowing the participation of the whole caring team and obtaining parents’ confidence and consent for donation.

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  1. Département d’anesthésie-réanimation, hôpital Necker-Enfants-malades, AP-HP, université Paris-Descartes, 149, rue de Sèvres, F-75743, Paris, France

    S. Blanot

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Correspondence to S. Blanot.

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Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2013 dans la session: Don d’organes en pédiatrie.

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Blanot, S. Gestion du donneur d’organes pédiatrique. Réanimation 22 (Suppl 2), 323–335 (2013). https://doi.org/10.1007/s13546-012-0628-9

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  • DOI: https://doi.org/10.1007/s13546-012-0628-9

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