PMID: 16615686Apr 18, 2006Paper

Cardiac organ donor management

Perfusion
Sana UllahMichael L Schmitz

Abstract

There is a critical shortage of donor organs. According to the United Network for Organ Sharing (UNOS), 20% of organs are discarded after procurement. Many of these may be potentially salvageable. Brain death is particularly detrimental to cardiac function. The initial sympathetic storm can produce direct myocardial injury. The ensuing spinal shock reduces global oxygen delivery. There is a change to anaerobic metabolism due to global mitochondrial dysfunction. Diabetes insipidus worsens hypovolemia and thyroid deficiency impairs cardiac function. Inadequate replacement of blood loss from trauma and coagulopathy worsens anemia and oxygen delivery. In the mid-1990s, the Papworth Hospital group in the UK advocated early invasive hemodynamic monitoring and administration of a 'hormonal cocktail', consisting of triiodothyronine (T3), vasopressin, methylprednisolone and insulin. This has been widely accepted and is endorsed by UNOS. Ventricular function, volume status and adequacy of resuscitation should be guided by invasive monitoring and serial echocardiography. Dopamine or epinephrine is used for inotropic support. If hypotension persists, vasopressin should be added which may allow reduction of inotropes. Donor lung function an...Continue Reading

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Citations

Sep 25, 2016·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Catherine KorteKaren Hardinger
Jan 22, 2009·Transplantation·Kimberley A GoldsmithSteven S L Tsui
Dec 3, 2013·Critical Care Nurse·Richard B Arbour
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Jul 7, 2019·Clinical Transplantation·Alexander KoganYael Peled
Mar 16, 2021·Annals of Plastic Surgery·Fabio Santanelli di PompeoJulian J Pribaz

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