Specefic problem

Care of the organ donor

Introduction

Despite efforts to increase deceased organ donation rates in Canada, recipient waiting

lists are increasing and the numbers of patients dying while waiting for an organ continue

to increase. It is, therefore, imperative to maximize the number of organs per donor, as well

as optimize donated organ function by proper implementation of practice guidelines in

donor management to promote better graft outcomes. Overall, this will translate into an

increase in the number of organs successfully transplanted

This chapter will discuss the physiological changes that occur with neurological

deter-mination of death (NDD), originally referred to as brain death, and will outline

general and organ-specific measures for investigating, monitoring and optimizing organ

donors

Physiogical changes associated with NDD

Neurological

Neurological determination of death is a result of acute brain injury, either traumatic or

nontraumatic, that causes acute intracranial hypertension.

If not managed early in its course, it may result in cerebral ischemia and subsequent

edema that progresses towards herniation of the brain through the foramen magnum.
The result isprogressive ischemia/infarction and worsening cerebral edema to the point

that cerebral circulation ceases.

Herniation of the brain usually causes ischemia of different parts of the brainstem, in a

rostral-caudal fashion.
 Pontine ischemia results in the classic Cushing response with bradycardia, hypertension

and irregular breathing patterns due to mixed sympathetic and vagal stimulation.
Unopposed sympathetic stimulation is seen, as function of the caudal portion of the

medulla is lost.
Ultimately, all brainstem function ceases and sympathetic denervation ensues with the

loss of spinal sympathetic pathways

The following are the effects of NDD on specific organ function.