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Die organprotektive Intensivtherapie bei postmortalen Organspendern

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Intensivmedizin und Management bei Organspende und Transplantation

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Zusammenfassung

Eine adäquate Intensivtherapie des Organspenders ist von entscheidender Bedeutung für den Transplantationserfolg. Neben der konsequenten Fortführung der allgemeinen intensivmedizinischen Maßnahmen (Bronchialtoilette, Lagerung, Beatmung) sind die frühzeitige Gabe von Desmopressin und die differenzierte Volumen- und Katecholamintherapie die primären Behandlungsmaßnahmen. Bei nicht stabilisierbarer Kreislaufinsuffizienz sind Kortikoide indiziert.

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Literatur

  1. Ali MJ (1994) Essentials of Organ Donor Problems and their Management. Anesthesiology Clin North America 12:655–671

    Google Scholar 

  2. Ali MJ, Wood G, Gelb AW (1992) Organ Donor Problems and their Management. Can J Anaesth 39:A125

    Google Scholar 

  3. Bamberger CM, Schulte HM (1997) Glucocorticoide-Teil 1. Internist 38:366–370

    PubMed  CAS  Google Scholar 

  4. Bhorade SM, Vigneswaran W, McCabe (2000) Liberalization of Donor criteria may expand the donor-pool without adverse consequence in lung. J Heart Lung Transplantation 19:1199–1204

    CAS  Google Scholar 

  5. Bittner HB, Chen EP (1997) Brain Death Alters Cardiopulmonary Hemodynamics and Impairs Right Ventricular Power Reserve against an Elevation of Pulmonary Vascular Resistance. Chest 111:706–711

    PubMed  CAS  Google Scholar 

  6. Bollaert P-E, Charpentier C, Levy B, Debouverle M, Audibert G, Larcan A (1998) Reversal of late septic shock with supraphysiologic dose of hydrocortisone. Crit Care Med 26:645–650

    PubMed  CAS  Google Scholar 

  7. Briegel J, Forst H, Haller M, Schelling G, Kilger E, Kuprat G, Hemmer B, Hummel T, Lenhart A, Heyduck M, Stoll C, Peter K (1999) Stress doses of hydrocortisone reverse hyperdynamic septic shock: A prospective, randomized, double-blind, single-center study. Crit Care Med 27:723–732

    PubMed  CAS  Google Scholar 

  8. Briegel J, Kellermann W, Forst H, Haller M, Bittl M, Hoffmann GE, Büchler M, Uhl W, Peter K (1994) Low-dose hydrocortisone infusion attenuate the systemic inflammatory response syndrome. Clin Investig 72:782–787

    Article  PubMed  CAS  Google Scholar 

  9. Cohen J, Chernov K, Ben-Shimon O (2002) Management of the brain-dead heart beating potential donor. IMAJ 4:243–246

    PubMed  Google Scholar 

  10. Darby JM, Stein K, Grenvik A, Stuart SA (1989) Approach to Management of the Heartbeating “Brain-Dead” Organ Donor. JAMA 261:2222–2228

    Article  PubMed  CAS  Google Scholar 

  11. Deutsche Stiftung Organtransplantation (Hrsg) (2003) Organspende und Transplantation in DeutscMand 2002, Neu-Isenburg, pp 6–17

    Google Scholar 

  12. Deutsche Stiftung Organtransplantation (Hrsg) (2003) Jahresbericht der Region Mitte 2002, Neu-Isenburg, pp 26–28

    Google Scholar 

  13. Deutsche Stiftung Organtransplantation (Hrsg) (2002) Organspende — Eine gemeinsame Aufgabe. Neu-Isenburg, Kapitel 5, pp 1–9

    Google Scholar 

  14. Dietrich H-J (2002) Bericht vom DAK 2002; HES 130/0,4: Volumenersatz ohne Beeinträchtigung der Nierenfuntion. Anästhesiologie & Intensivmedizin 43:646–647

    Google Scholar 

  15. Dowling RD, Williams P, Zenati M (1995) Infections and pathologic factors in the donor lung. J Thorac Cardiovasc Surg 109:1263–1264

    PubMed  CAS  Google Scholar 

  16. Fisher AJ, Dark JH, Corris PA (1998) Improving donor lung evaluation: a new approach to increase organ supply for lung transplantation. Thorax 53:818–820

    PubMed  CAS  Google Scholar 

  17. Fisher AJ, Donnelly SC, Hirani (1999) The effect of donor lung inflammation on outcoming human lung transplantation. Thorax 54:180

    Google Scholar 

  18. Fitzgerald RD (1997) Management of the brain-dead organ donor. Saudi J Kidney Dis Transplant 8:21–31

    Google Scholar 

  19. Follette D, Rudich S, Bonacci C, Allen R, Hoso A, Albertson T (1999) Importance of an aggressive multidisciplinary managment approach to optimize lung donor procurement. Transplant Proc 31:169–170

    Article  PubMed  CAS  Google Scholar 

  20. Follette DM, Rudich SM, Babcock WD (1997) Improved oxygenation and increased lung donor recovery with high-dose steroid administration after brain death. J Heart Lung Transplant 17:423–429

    Google Scholar 

  21. Garcia-Fages LC, Antolin M, Cabrer C, Talbot R, Alcaraz A, Lozano F, Manyalich M (1991) Effects of Substitutive Triiodthyronine Therapy on Intracellular Nucleotide Levels in Donor Organs. Transplant Proc 23:2495–2496

    PubMed  CAS  Google Scholar 

  22. Goarin J-P, Cohen S, Riou B (1996) The Effects of Triiodothyronine on Hemodynamic Status and Cardiac Funktion in Potential Heart Donors. Anesth Analg 83:47–49

    Google Scholar 

  23. Halejcio-Delephont P, Siaghy EM (1998) Consequences of brain death on coronary blood flow and myocardial metabolism. Transplant Proc 30:2840–2841

    Google Scholar 

  24. Haverich A, Warnecke G, Fischer S (2002) Critical donor organs for heart and lung transplantation: Quantification of transplant qualitiy. Chir Gastroenterologie 18:18–23

    Google Scholar 

  25. Hebert PC, Wells G, Blajchman MA, Marshall J, Martini C, Pagliarello G, Tweedale M, Schweitzer I, Yetsir E (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 340:409–417

    Article  PubMed  CAS  Google Scholar 

  26. Holmquist M, RN; Chabalewski F (1999) A Critical Guiding Care of Organ Donors. Critical Care Nurse 19:84–98

    PubMed  CAS  Google Scholar 

  27. Jeevanandam V, Todd B, Hellmann S, Eldridge C, McClurken J, Addonizio P (1993) Use of Triiodthyronine Replacement Therapy to Reverse Donor Myocardial Dysfunction: Creating a Larger Donor Pool. Transplant Proc 25:3305–3306

    PubMed  CAS  Google Scholar 

  28. Jeevanandam V (1997) Triiodothyroine: Spectrum of Use in Heart Transplantation. Thyroid 7:139–145

    PubMed  CAS  Google Scholar 

  29. Katz K, Lawler J, Wax J, O’Connor R, Nadkarni V (2000) Vasopressin pressor effects in eritically ill children during evaluation for brain death and organ recovery. Resuscitation 47:33–40

    Article  PubMed  CAS  Google Scholar 

  30. Kinoshita Y, Yahata K, Yoshioka T, Onishi S, Sugimoto T (1990) Long-term renal preservation after brain death maintained with vasopressin and epinephrine. Transplant Int 3:15–18

    Article  CAS  Google Scholar 

  31. Kolin A, Norris J (1984) Myocardial Damage from Acute Cerebral Lesions. Stroke 15:990–993

    PubMed  CAS  Google Scholar 

  32. Kono T, Nishina T (1999) Usefulness of Low-Dose Dobutamine Stress Echocardiography for Evaluating Reversibility of Brain Death-Induced Myocardial Dysfunction. Am J Cardiol. 84:578–582

    Article  PubMed  CAS  Google Scholar 

  33. Lassie P, Sztark F, Thicoiepe M (1995) Donor Criteria for lung transplantation: a retrospective study. Transplant Proc 27:2532

    PubMed  CAS  Google Scholar 

  34. MacLean A, Dunning J (1997) The retrieval of thoracic organs: donor assessment and management. Brit Med Bulletin 53:829–843

    CAS  Google Scholar 

  35. Macoviak JA, McDougall IR, Bayer MF (1986) Significance of thyroid dysfunction in human cardiac allograft procurement. Transplantation 43:824–826

    Google Scholar 

  36. Massei R, Martini C, Parma A, Cala (1993) Management of multiple organ donor: respiratory a metabolism-related problems. Minerva Anestesiologica 59:97

    PubMed  CAS  Google Scholar 

  37. Matsumura Y, Okada Y, Shimada K (2002) Assessment of Brain-Dead Cadaver Donor for Lung Transplantation. Transplant Proc 34:2585–2586

    Article  PubMed  CAS  Google Scholar 

  38. McAdams DE, Bearden C, Headrick TR (1995) Use of thyroid replacement therapy in donor management. J of Transplant Coordination 5:117–120

    Google Scholar 

  39. Nagareda T, Kinoshita Y, Tanaka A, Hasuike Y, Terada N, Nishizawa Y, Fujita M (1989) Clinicopathological Study Of Livers From Brain-Dead Patients Treated With A Combination of Vasopressin And Epinehrine Transplantation 47:792–797

    CAS  Google Scholar 

  40. Nehammmer K (2000) Hormonsubstitution bei hirntoten Organspendern. Novartis, wissenschaftliche Dokumentation 2000

    Google Scholar 

  41. Novitzky D (1991) Triiodothyroine Replacement, the Euthyroid Sick Syndrome, and Organ Transplantation. Transplant Proc 23:2460–2462

    PubMed  CAS  Google Scholar 

  42. Novitzky D, Cooper DK (1988) Results of hormonal therapy in human brain-dead potential organ donors. Transplant Proc 20:59–62

    PubMed  CAS  Google Scholar 

  43. Novitzky D, Cooper DK, Chaffin JS (1990) Improved cardiac allograft function following trioiodothyronine therapy to both donor and recipient. Transplantation 49:311–316

    PubMed  CAS  Google Scholar 

  44. Novitzky D, Cooper DKC, Morrell D, Isaacs S (1987) Triiodothyronine Depletion, and Inhibition of Oxidative Phosphorylation: Relevance to Management of Organ Donors. Transplant Proc 5:4110–4111

    Google Scholar 

  45. Novitzky D, Cooper DKC, Reichart B (1987) The Value of Hormonal Therapy in Improving Organ Viability in the Transplant Donor. Transplant Proc 19:2077–2088

    Google Scholar 

  46. Novitzky D, Cooper DKC, Reichhhart B (1987) Hemodynamik and metabolic responses to hormonal therapy in brain-dead potential organ donors. Transplantation 43:852–864

    PubMed  CAS  Google Scholar 

  47. Novitzky D, Cooper DKC, Rose AG, Fraser RC, Barnard CW (1988) Change from Aerobic to Anaerobic Metabolism after Brain Death and Reversal Following Triiodothyroine Therapy. Transplantation 45:32–36

    PubMed  CAS  Google Scholar 

  48. Novitzky D, Wicomb WN, Cooper DKC et al (1984) Elektrocardiographik, Hemodynamic and Endocrine Changes during Experimental Brain Death in the Chacma Baboon. Journal of Heart Transplant 4:63

    Google Scholar 

  49. Novitzky D (1996) The Role of Triiodothyronine in Cardiac Transplantation. Thyroid 5:531–536

    Google Scholar 

  50. Orlowsky JP (1993) Evidence that thyroxine (T4) is effective as a hemodynamic rescue agent in management of organ donors. Transplantation 55:959–960

    Google Scholar 

  51. Pennefather SH, Bullock RE. (1993) Triiodothyronine treatment in brain-dead multiorgan donors — a controlled study. Transplantation 55:1443–1447

    PubMed  CAS  Google Scholar 

  52. Pennfather SH, Bullock RE (1995) Use of Low Dose Arginine Vasopressin To Support Brain-Dead Organ Donors. Transplantation 59:58–62

    Google Scholar 

  53. Pickett JA, Wheeldon D, Oduro A (1994) Multi-Organ Transplantation: donor managment. Cur Op Anaesth 7:80–83

    Google Scholar 

  54. Powner DJ, Darby JM (2000) Management of Varirations in Blood Pressure During Care of Organ Donors. Progress in Transplantation 10:25–32

    PubMed  CAS  Google Scholar 

  55. Powner DJ, Kellum JA (2000) Maintaining Acid-Base Balance in Organ Donors. Transplantation 10:98–105

    CAS  Google Scholar 

  56. Randell TT, Höckerstedt KAV (1993) Triiodothyroine Treatment is Not Indicated in Braindead Multiorgan Donors: A Controlled Study. Transplant Proc 25:1552–1553

    PubMed  CAS  Google Scholar 

  57. Rosendale JD, Kauffmann HM, McBride MA (2003) Aggressive pharmacologic donor management results in more tansplanted organs. Transplantation 75:482–487

    PubMed  Google Scholar 

  58. Rosendale JD, Chabalewski FL, McBride MA, Garrity ER, Rosengard BR, Delmonico FL, Kauffmann HM (2002) Increased Transplanted Organs from the Use of a Standardized Donor Managment Protocol. Am J Transplant 2:761–768

    Article  PubMed  Google Scholar 

  59. Salim Ali, Vassiliu Patelis (2001) The role of thyroid hormone administration in potential organ donors. Arch Surg 136:1372–1380

    Google Scholar 

  60. Sebening C, Hagl C, Szabo G et al (1995) Cardiocirculatory Effects of Acutely Increased Intracranial Pressure and Subsequent Brain Death. Eur J Cardiothorac Sur 9:360–372

    CAS  Google Scholar 

  61. Shumway SJ, Hertz MI, Patty MG, Bolman RM III (1994) Liberalization of Donor Criteria in Lung and Heart-Lung Transplantation. Am. Thoracic Surgery 57:92–95

    CAS  Google Scholar 

  62. Sielenkämper A, Bone H-G, Booke M (2001) Anämie, Bluttransfusion und Gewebeoxygenation. Anästhesiologie & Intensivmedizin 42:304–313

    Google Scholar 

  63. Spiss CK (1997) Managment of the Multi-Organ Donor. ACTA Anaesthesiologica Scandinavica 111:77

    PubMed  CAS  Google Scholar 

  64. Spiss CK, Metnitz PH, Schäfer B, Steltzer H (1995) Recent advances in transplantation anesthesia and intensive care medicine. Transplant Proc 27:2532–2537

    Google Scholar 

  65. Stoica SC, Satchithananda DK (2002) Swan-Ganz catheter assessment of donor hearts: outcome of Organs with borderline hemodynamics. J Heart Lung Transplant 21:615–622

    PubMed  Google Scholar 

  66. Straznicka M, Follete DM, Eisner MD (2002) Aggressive management of lung donors classified as unacceptable: Excellent recipient survival one year after transplantation. Thorac Cardiovasc Surg 124:250–258

    Google Scholar 

  67. Timek T, Bonz A, Dillmann R, Vahl U (1998) The Effect of Triiodothyronine on Myocardial Contractile Performance after Epinephrine Exposure. J Heart Lung Transplantation 17:931–939

    CAS  Google Scholar 

  68. Timek T, Bonz A (1998) The Effect of Triiodothyroine on Myocardial Contractile Performance After Epinephrine Exposure: Implications for Donor Heart Management. J Heart Lung Transplant 17:931–940

    PubMed  CAS  Google Scholar 

  69. Toda R, Kawai A, Moriyama Y, Taira A, Ferraro P, Griffifh BP (1999) Evaluation and Procurement of Donor Heart and Lung in Multiple Organ Harvesting. Transplant Proc 31:2006–2011

    Article  PubMed  CAS  Google Scholar 

  70. Van den Berghe G, Wouters P et al (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345:1359–1367

    PubMed  Google Scholar 

  71. Weill D (2002) Donor Criteria in Lung Transplantation. Chest 121:2029–2031

    Article  PubMed  Google Scholar 

  72. Weiss SJ, Muniz A, Ernst AA, Lippton HL, Nick TG (2000) The effect of prior hypothermia on the physiological response to norepinephrine. Resuscitation 45:201–207

    Article  PubMed  CAS  Google Scholar 

  73. Yoshioka T, Sugimoto H, Uenishi M, Sakamoto T, Sadamitsu D (1986) Prolonged Hemodynamic Maintenance by the Combined Administration of Vasopressin and Epinephrine in Brain Death: A Clinical Sudy. Neurosurgery 18:565–567

    PubMed  CAS  Google Scholar 

  74. Wesslau C, Eferer K, Krüger R et al (1998) Untersuchungen von ausgewählten hämodynamischen, endokrinologischen und Entzündungsparametern beim Organspender und deren mögliche Beeinflussung durch die Gabe von Methylprednisolon. Transplantationsmedizin (suppl) 1998; 130

    Google Scholar 

  75. Zaroff JG, Rosengard BR (2002) Consensus Conference report: maximising use of organs recovered from the cadaver donor. Circulation 106:836–841

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Organisationszentrale der Region Mitte, Deutsche Stiftung Organtransplantation, Adam-Karrillon-Straße 23, 55118, Mainz

    PD Dr. med. Dietmar Maue & Dr. Kai Nehammer

  2. Organisationszentrale der Region Bayern, Deutsche Stiftung Organtransplantation, Marchionistr. 15, 81377, München

    Dr. Detlef Bösebeck

  3. Organisationszentrale der Region Nord-Ost, Deutsche Stiftung Organtransplantation, Saatwinkler Damm 11-12, 13627, Berlin

    Dr. Claus Wesslau

Authors
  1. PD Dr. med. Dietmar Maue
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  2. Dr. Kai Nehammer
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  3. Dr. Detlef Bösebeck
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  4. Dr. Claus Wesslau
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Editors and Affiliations

  1. Region Mitte Organisationszentrale, Deutsche Stiftung Organtransplantation, Adam-Karrillon-Str. 23, 55118, Mainz

    Dietmar Mauer

  2. Krankenhaus-Kommunikation, Deutsche Stiftung Organtransplantation, Emil von Behring-Passage, 63263, Neu-Isenburg

    Doris Gabel

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Maue, D., Nehammer, K., Bösebeck, D., Wesslau, C. (2006). Die organprotektive Intensivtherapie bei postmortalen Organspendern. In: Mauer, D., Gabel, D. (eds) Intensivmedizin und Management bei Organspende und Transplantation. Steinkopff. https://doi.org/10.1007/3-7985-1611-1_3

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