Organ Donation in Critical Care
Organ donation is considered the “gift of life”, as a person donates one or more of their organs to people in need of those. Deceased organ donation is based on the “dead donor rule” which supports vital organs to be taken only from persons declared dead. To meet this rule, the deceased donation has been developed around two different programs: donation after death confirmed using neurological criteria (brain stem death or brain death—DBD) and donation after circulatory death (DCD).
DBD or “heart-beating donation” allows organ donation to take place before apnea results in cardiac arrest. Compared with donation after circulatory death, it offers the opportunity to retrieve more organs. As brain death is followed by a cascade of physiological changes, the therapeutic focus should be on organ physiology restoration.
The DCD programs allow the donation and retrieval of organs from patients whose death has been confirmed using cardiorespiratory criteria and usually is referred as “non-heart-beating” organ donation. The accurate confirmation of death is crucial as all donors should follow the “dead donor rule”. As the cardiovascular system collapses, the organs are exposed to warm ischaemic time, and efforts to prevent or alter the effect of this are of paramount importance.
KeywordsBrain dead Determination of death Organ donation Organ procurement Warm ischaemic time
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