Optimisation of the organ donor and effects on transplanted organs: a narrative review on current practice and future directions.

Abstract:

:Mortality remains high for patients on the waiting list for organ transplantation. A marked imbalance between the number of available organs and recipients that need to be transplanted persists. Organs from deceased donors are often declined due to perceived and actual suboptimal quality. Adequate donor management offers an opportunity to reduce organ injury and maximise the number of organs than can be offered in order to respect the donor's altruistic gift. The cornerstones of management include: correction of hypovolaemia; maintenance of organ perfusion; prompt treatment of diabetes insipidus; corticosteroid therapy; and lung protective ventilation. The interventions used to deliver these goals are largely based on pathophysiological rationale or extrapolations from general critical care patients. There is currently insufficient high-quality evidence that has assessed whether any interventions in the donor after brain death may actually improve immediate post-transplant function and long-term graft survival or recipient survival after transplantation. Improvements in our understanding of the underlying mechanisms following brain death, in particular the role of immunological and metabolic changes in donors, offer promising future therapeutic opportunities to increase organ utilisation. Establishing a UK donor management research programme involves consideration of ethical, logistical and legal issues that will benefit transplanted patients while respecting the wishes of donors and their families.

journal_name

Anaesthesia

journal_title

Anaesthesia

authors

Bera KD,Shah A,English MR,Harvey D,Ploeg RJ

doi

10.1111/anae.15037

subject

Has Abstract

pub_date

2020-09-01 00:00:00

pages

1191-1204

issue

9

eissn

0003-2409

issn

1365-2044

journal_volume

75

pub_type

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