Good question. I'm assuming no.Originally Posted by Nancy Drew
Good question. I'm assuming no.
I'm kind of leaning towards no. It was a publicity stunt to bring organ donation awareness and well played. And, if he did bury it it still symbolizes burying a perfectly good body full of life saving organs.
I think I love him.
I figured no but I wanted to know haha.
I'm interested in knowing, too. Either way I'm cool with it, but I have the curiosity.
That was a wonderful way to symbolize the value of Organ Donation. Genius to link it to a commodity that most people can understand.
You are right, I think that is why it might resonate a little bit longer than the "normal" message. It is unfortunate that the appeal has to be made at that level, but if it works....
this belongs in the cry about it thread too. Shit.
I saw this a few minutes ago and immediately thought of this thread.
Made me sob.
Ohio's governor has postponed the execution of a child-killer so he can study his offer to donate organs ? a proposal that experts say would be a logistical nightmare and an ethical minefield.
Ohio Governor John Kasich issued a last-minute stay of execution to consider a condemned child killer's plea to donate his organs to ailing family members. WCMH's Liz Adeola reports.
"The only options for executing someone to obtain vital organs is to either shoot them in the head or chop their head off and have a team of doctors ready to step in immediately," said Arthur Caplan, a professor of medical ethics at NYU Langone Medical Center.
Theoretically, he said, the method of execution could be the removal of the organs under anesthesia.
"The problem is no doctor is going to do it," he said. "It violates all medical ethics and now you're making the doctor the executioner."
Those are some of the practicalities that Ohio Gov. John Kasich will have to consider as he explores the possibility of allowing death-row inmate Ronald Phillips, 40, to give his organs to ailing relatives or members of the public.
Phillips, who was convicted of raping and beating to death his girlfriend's 3-year-old in 1993, was one day away from a lethal injection when Kasich stayed his execution so he could weigh his donation request.
"I realize this is a bit of uncharted territory for Ohio, but if another life can be saved by his willingness to donate his organs and tissues then we should allow for that to happen," the first-term Republican said in a statement.
Some ethicists say the life-for-a-life equation isn't that simple.
The United Network for Organ Sharing, the non-profit organization that coordinates transplants across the country, called the scenario "ethically troubling."
"Allowing condemned prisoners to donate organs could provide an inappropriate incentive to execute prisoners and could lead to significant human rights violations," Alexandra Glazier, head of UNOS' ethics committee, said in a statement.
She said allowing prisoners facing death to donate organs could also muddy the ideal of "coercion-free consent."
"Taking organs from a condemned prisoner is not generally seen as an ethically appropriate way for the U.S. to expand the availability of organs for transplantation."
But Sally Satel, a psychiatrist who is a scholar at the American Enterprise Institute, said a donation policy would be "humane" ? both for people actively waiting for organs and for killers who are trying to make amends.
"Every organ helps," she said.
Satel scoffed at the notion that the possibility of a post-execution donation would encourage juries and judges to impose capital punishment.
"It's an absurd and morbid fantasy," she said. "This is just the kind of outlandish scare tactic people use when they have no rational arguments against the issue."
There are more than 77,000 people actively waiting for organs, and the demand far outstrips the supply, according to UNOS.
With the number of executions in the U.S. hovering between 40 and 50, organs from death row are not going to solve the chronic shortage, Caplan said.
To donate a organ, a person usually has to die from a head injury that destroys the brain but leaves the rest of the body functioning. Life support is used to keep blood flowing to the organs until they are removed.
He said electrocution or lethal injection would injure the organs. Plus, the organs would have to be removed within five minutes to remain viable, which is not enough time to complete the formalities legally required in an execution.
The prison population would likely yield low-quality organs because of diet, lack of exercise and the high-rate of drug-related diseases such as HIV and hepatitis, Caplan said.
Dr. Jay Pal, a heart and transplant surgeon at the University of Washington Medical Center, said that even though up to seven people could benefit from the organs of a executed prisoner, he would not be comfortable with the process.
"It's very different to remove organs from someone who died in a car accident than it is to remove something from someone who is still alive," he said.
"I understand that person may not be alive for much longer for whatever crimes, but me personally, I think it would be very difficult knowing that's the act that killed somebody."
Phillips isn't the first death-row inmate to make the request. Christian Longo, facing execution for the murder of his wife and three children, asked to do the same two years ago and was turned down by authorities in Oregon.
Defense lawyer Tim Sweeney said his client has been praying and reflecting a lot in recent weeks as his final appeals ? including a challenge to Ohio's plan to use an untested drug cocktail for the lethal injection ? have been rejected.
He said that when he told Phillips about the seven-month reprieve, his reaction was: "God is good."
"Our client was very grateful the governor is going to give him time to explore this," Sweeney said.
"He'll have 230 more days of life and that's a very special thing. Hopefully he'll have the opportunity to do some good with that time if he's allowed to donate his organs."
http://usnews.nbcnews.com/_news/2013...l-hurdles?lite
what a non-issue, but an ingenious tactic for this guy!
Just curious, why is it a non-issue?
you can't kill people for their organs, even if they are set to die... also, there is no humane way to do it in practice in the united states. i think it's ridiculous to hold the execution and spend money on trying to research this for a total of 7 organs, and i think this is an ingenious ploy to stay the execution.
(i am anti-death penalty, to be clear, i just think that it is dumb to entertain this idea and dangerous if it was to be taken seriously.)
I don't find it a non-issue at all. Obviously you can't kill people for their organs...but some of the organs can be donated without the result of death (one kidney, corneas, etc) and if they want to do it then I definitely think it's an issue for discussion. I'm not saying it should or shouldn't be done, but in the face of organ shortage with someone offering to donate, it's definitely something to think about. Ethics aside, the environment that prisoners live in may make it unfeasible (disease, nutrition, etc), but again it should be investigated.
I agree though that he's gained some time using this ploy and it will probably come to nothing.
What really cracks me up is the amount of people who gasp like they are being offered jelly instead of all fruit because it's organs from a prisoner. (run on sentence and I don't care) Not anyone here, but the talk on some of the media pages.
Many, many, MANY organ donors are criminals. MANY of them died during the commission of a crime. Some died in other manners. BUT, many organ donors have a criminal history. There are plenty of criminals who become organ donors that do not have an arrest history. I'm sure there are rapists, pedos, embezzlers, wife beaters, etc. who have not been caught who have donated organs.
A prison environment is really no different than the environment criminals live in on the outside, if you really think about it. They are hanging out with the same type of people on the outside as they do on the inside. Actually, they probably get more exercise on the inside than they do on the outside.
Disease does not deter many transplant centers anymore. If a potential donor has hepatitis or HIV/AIDS; those organs will only be considered for patients who already suffer from the same.
I don't have an issue with this guy donating his kidneys prior to death. People donate kidneys on the regular while still alive.
The issue is cardiac death. Once his heart stops he is no longer a candidate for organ donation. He can donate his tissues; skin, eyes, bone, etc., but he can no longer be a solid organ donor candidate.
IF they can kill him and cause brain death, while he is on a ventilator, then there is the potential he could donate all 8 life saving organs (I read an article up thread where a "professional" said there is only 7 organs to be donated. 2 kidneys, 2 lungs (which can actually be split into multiples), 1 liver (which can be split), 1 pancreas, 1 heart, 1 small intestine = 8 organs)
If is the operative word. They would have to severe his brain stem to guarantee brain death because the brain stem reflexes (or lack there of) is what determines brain death. There is no room for error, but I do believe it can be done humanely. However, I do not think the logistics/moral/ethical issues can be worked out in 7 months.
I do not know if the drugs to be used to kill him will damage the organs. Look at it this way; the drugs may damage the organs, but let's say they still worked, but were considered marginal. If there is a kidney recipient who has been on dialysis for years, they are more likely to accept a marginal kidney if it gets them off dialysis for a year or two (maybe longer). Just because an organ may be "damaged" or "marginal" does not mean they are useless. There is a potential they will not work once transplanted, but that goes for ANY organ. Even the "pristine" ones. Transplant is a crap shoot and the only way to positively know if an organ will work is to transplant it.
Excellent articles, RBW!
The bold is extremely important, IMO.
This article is, basically, suggesting a return to how organ donation originally started, except with a little twist. Time. Organ donation started out with donors who suffered cardiac arrest. Whether it be trauma or sudden collapse. Unfortunately, the organs didn't fair well. When brain death criteria was introduced(becoming a donor while suffering brain death on a ventilator) transplant survival rates soared. The key is organ perfusion.
DCD, Donation After Cardiac Death (formerly known as NHBD-Non Heart Beating Donor), has never stopped occurring, it just isn't talked about as much as BD donors. At this point. DCD is done in a controlled environment and these are people who still have at least one brain stem reflex left. They are not people who are in vegetative states or comas. These are people who will never recover from their current state, but have not advanced to clinical brain death. Back in the day the person would be extubated on the hospital floor and once the person took their last breath there would be a 5 minute waiting period and then cardiac death pronounced. The procurement team would wheel the donor down to the OR, the donor would be quickly prepped, and the kidneys (sometimes pancreas and liver) would be procured. I would be sitting down in the OR waiting to receive the phone call that the donor expired. We used to wait 3 hours, but it was found the organs didn't fair well. Then we went to 1- 1 /12 hours. Now, the donors are extubated in the OR and the procurement team(s) have to wait outside the OR until the person is pronounced dead. Once the pronouncement is made the procurement team works quickly to remove the organs. Kidneys are placed on the pump and do very well.
Hearts and lungs are currently being placed on machines to help preserve them for transplant in France. Hearts are next. The machines are manufactured in the U.S., but have not been approved here. I wonder if the clinical trial mentioned in NC is utilizing this machine.
Pretty awesome stuff.
I had to snip
I'm curious...what percentage of donations are DCD?
I honestly don't know the percentages anymore, but they used to be about 1-2% of BD donors. That's not to be confused with the percentage of people who are eligible to be brain death donors, but actual brain death donors.
Not all OPO's were utilizing DCD donors. Several years ago it was mandated that all OPO's prepare for them and start checking the criteria and assessing patients for the potential. How many OPO's have actually implemented the processes, I'm not sure.
Why even have criteria.
Pretty much.Why even have criteria.
I mean, there are rules so there is no trafficking, so rich people can't buy them up, and so people are treated as fairly as possible.
Thought everybody might like this story.
There are even pictures. It's a powerful story.
http://www.tampabay.com/features/hum...organs/2158684
BINGO!
This was a great story. The shelf life of the organs is inaccurate-they are much longer than written, but it is a great article.
In response to crickets in the Jahi McMath thread. I did not want to clog her thread up arguing over brain death management. I don't know how to link a specific post.
http://mydeathspace.com/vb/showthrea...tonsils/page16
The information is for organ donor management which is the management of a brain dead person.
Direct link from the National Institute of Health to:
BRITISH JOURNAL OF ANESTHESIA
http://www.ncbi.nlm.nih.gov/pubmed/22194439
http://bja.oxfordjournals.org/conten...ppl_1/i96.full
..brain death is often associated with marked physiological instability, which, if not managed, can lead to deterioration in organ function…
There is increasing evidence that moderation of these pathophysiological changes by active management in Intensive Care maintains organ function, thereby increasing the number and functional quality of organs….
This strategy of active donor management requires an alteration of philosophy and therapy on the part of the intensive care unit clinicians and has significant resource implications if it is to be delivered reliably and safely.
…as the widespread physiological changes that occur during brain death are avoided. In addition to acute changes, which if untreated lead to rapid deterioration and cardiac arrest (even if ventilation is continued), there are ongoing generalized inflammatory and hormonal changes associated with brain death which adversely affect donor organ function and propensity to rejection. Analysis of the outcomes of kidney transplants to two recipients from the same donor, or of dysfunction in multiple organ transplants from the same donor, suggests that the quality of donor management (active care of the donor from the time of diagnosis of brain death until retrieval and preservation of organs) is a major determinant of the outcome of DBD donation.
In essence, donor management is a continuation of previous critical care management, but with a shift in goals. It is as at least as rigorous as previous care, may even be more so, and should be delivered in an intensive care unit (ICU) by experienced staff.
Subsequent research into the physiology of brainstem death stimulated the introduction into clinical practice of new therapies, based on experimental laboratory data. Cardiac transplant centres formed teams to attend donor hospitals and institute advanced cardiovascular monitoring, including pulmonary artery catherization. With additional information and physiologically targeted treatment, they added a ‘cocktail’ of hormones and steroids to therapy. Using such regimens, they were able to reduce catecholamine infusions and improve haemodynamics, and in one study, 92% of donors previously deemed unacceptable achieved target transplantation values. This led to initiatives to standardize and then disseminate agreed therapies and physiological targets.
The United Network for Organ Sharing (UNOS) Critical Pathway for the Organ Donor was introduced in the USA in 1999. This pathway recommended defined physiological goals and a consistent and active approach to donor management, including treatments and monitoring. In a pilot introduction of the pathway, the numbers of organs retrieved and transplanted per DBD increased by 10.3% and 11.3%, respectively. There was also a 19.5% increase in the hearts transplanted. The pathway was subsequently modified to include a package of treatment comprising methylprednisolone, vasopressin, and triiodothyronine (T3) or l-thyroxine. This was termed ‘hormonal resuscitation’ (HR) and the pathway was extended to a wider and different population. Retrieval rates after HR increased in comparison with historic controls, although those receiving HR were younger, less likely to have died from stroke, and had fewer comorbidities. More data are required.
Other therapeutic goals and treatment guidelines have been produced, based on expert opinion and current research.
Table 2
Suggested cardiovascular goals for the active management of potential
Review ICU therapeutic goals and alter to donor goals.
Use cardiac output monitoring if possible to titrate fluids and inotropic or pressor drugs to intended goals as guided by retrieval team. If vasopressor drugs required, vasopressin 0–2.4 units h−1* may reduce catecholamine requirements. High doses of catecholamines (e.g. norepinephrine >0.05 μg kg−1 min−1) should be avoided if possible. Consider triiodothyronine bolus and infusion*
http://bja.oxfordjournals.org/conten...expansion.html
… more work is needed as currently evidence-based ICU care is not always delivered reliably for patients or donors.
Fluid administration is closely linked to cardiovascular function and vascular tone. Early workers used vasopressors such as metaraminol, but dopamine and other catecholamines rapidly became popular, and are commonly used for the first-line cardiovascular support. Catecholamines have anti-inflammatory and preservation effects,86–88 and are liberally used by some transplant retrieval services, including for cardiac donation. However, the use of high doses of norepinephrine (>0.05 μg kg−1 min−1) in donors is associated with increased cardiac graft dysfunction, particularly right ventricular performance, and higher early and late mortality in recipients.
The utility of low-dose vasopressin to treat diabetes insipidus, aid restoration of vascular tone, and reduce epinephrine requirement was first identified in brain-dead patients receiving long-term support. When the loss of vascular tone is preventing achievement of donor goals, low-dose vasopressin may allow reduction or elimination of catecholamine use, as in other ICU patients. In a study of 80 organ donors, Venkateswaran and colleagues were able to reduce or eliminate norepinephrine infusions by adding vasopressin. Terlipressin has been used for similar purposes. Canadian guidelines recommend vasopressin as the first-choice vasopressor for donor resuscitation.38
Experimental animal and database evidence confirms that kidneys are vulnerable to catecholamine-induced ischaemia at the time of brain death, and subsequent hypoperfusion if donor management is inadequate.
Cardiovascular support usually includes the administration of catecholamines, and dopamine is used in several countries. Dopamine has no significant renal protective effect on renal function in the critically ill and can be deleterious in donors if fluid management is inadequate, but might have beneficial effects in renal transplantation. The mechanism here could be related to moderation of preservation injury and inflammation, donor cardiovascular effects, or recipient treatment.
Physiological support in the operating theatre
A multiple organ donation procedure involves midline laparotomy extended by sternotomy, even if thoracic organs are not to be retrieved. There is potential for significant blood loss and hypothermia. Surgical manipulations cause cardiovascular instability, and vasoactive infusions are likely to be in progress. Maintaining stability during the procedure allows unhurried removal of organs in optimum undamaged condition. This can be demanding, and ideally donor support is provided by an appropriately experienced individual from anaesthesia or critical care.
Spinal reflex movements are common and full neuromuscular block is required. Hypertension and increased plasma catecholamine concentrations have been observed during surgery and attributed to spinal reflexes. These can occur spontaneously or on surgical stimulus and have prompted some to suggest that anaesthesia for organ donors is required. However, marked spinal reflexes have been observed in the brain dead with liquefied cortex and cardiovascular changes are both generated and modifiable at spinal cord level alone. Hypertension may be moderated with vasodilators, opiates, or volatile anaesthetic agents. In addition, volatile anaesthetics may induce ischaemic preconditioning in hepatic and cardiac surgery. For this reason, some retrieval teams administer them during the last 30 min before aortic clamping.
D.W.McK. is a transplant anaesthetist and has assisted with the Clinical Leads for Organ Donation Professional Development Programme for NHSBT. R.S.B. is a cardiothoracic transplant surgeon and Chair of the Cardiothoracic Advisory Group of NHSBT. J.A.K. is an Intensivist and principal investigator of a clinical trial examining protocol-guided donor resuscitation (NCT00987714). All are actively involved in organ donor management including audit and research.
Link from NIT.
http://www.ncbi.nlm.nih.gov/pubmed/18636057
http://www.minervamedica.it/en/getfr...09N03A0125.pdf
Department of Anesthesiology and Intensive Care, S. Giovanni Battista-Molinette Hospital, University of Turin, Turin,
Italy;
Unit of Anesthesia and Intensive Care, Department of Neurosciences, Bellaria Hospital, Bologna, Italy
Only 15-20% of individuals who satisfy criteria for becoming organ donors actually
donate.
Many reasons may account for this discrepancy, such as the lack of consent, the absence of an experienced coordinator team able to solve logistical problems, the use of strict donor criteria, and suboptimal, unstandardized critical care management of potential organ donors.
This has resulted in efforts to improve the medical care delivered to potential organ donors so as to reduce the organ shortage, improve the conversion rate, increase organ procurement, and promote graft survival.
5% to 10% of potential donors suffer cardiac arrest and their organs can no longer be harvested, mainly due to insufficient or inaccurate physiological and therapeutic support (defined as“biological reanimation” of the brain dead subject, “donor maintenance,” or “donor intensive treatment”).
Preventing or attenuating organ dysfunction in pulsatile heart beating potential donors requires in-depth knowledge of the pathophysiological consequences of brain death. This accounts for the growing interest in donor management, a topic widely considered the most neglected area in transplant medicine. After the declaration of brain death, treatment of the potential organ donors should aim to curtail progressive somatic deterioration, and sustain or improve specific transplantable organ function. Conserving optimal donor physiology and stability preserves organ quality, viability, and eventually organ function in the recipient. For this purpose, organ perfusion must be optimized, endocrine homeostasis stabilized, and the weaker organs safeguarded.
In clinical practice, hypotension (>80% of donors), diabetes insipidus (65%), relative hypothermia, and plasma electrolyte imbalance (namely natremia) are more common than disseminated intravascular coagulation, cardiac arrhythmias, pulmonary edema, and metabolic acidosis.
Strategies for the management of organ donors exist and consist of the normalization of donor physiology.
Maintaining hemodynamic sufficiency and stability in brain dead patients until organ procurement is paramount to organ viability. The progression of intracranial hypertension
brain stem infarction causes death of the vasomotor centers (loss of blood pressure autoregulation) and a loss of sympathetic tone with a massive reduction of systemic vascular resistance and profound vasodilation. Subsequently, severe relative hypovolemia (venular blood pooling) and hypotension occur, sometimes leading to multifactorial cardiac dysfunction. Not all of these physiologic changes are serious in every potential organ donor,but during the observation period, hemodynamic instability is common. Furthermore, the degree of instability appears to be directly related to the time of post mortem development and consequential degree of autonomic dysfunction.
The goals of management for the donor’s hemodynamic status are to achieve normovolemia by volume expansion, maintenance of blood pressure, and optimization of cardiac output so as to
reach perfusion pressure and blood flow gradients that promote organ function with the least support of vasoactive drugs. These compounds often represent a vasoconstrictive load potentially inducing organ ischemia
In addition, donors need to be considered for volume expansion therapy (crystalloids and/or colloids), the use of vasopressor drugs at the lowest possible dosage (dopamine, noradrenaline), and inotropic support (dobutamine) if cardiac failure occurs
Cardiovascular support should be based on rational physiology and the use of vasopressors to maintain donor stability has been shown to improve organ viability, thereby increasing the recipient’s survival rate.
There are widely divergent opinions regarding the best inotrope or vasopressor agents for intensive donor management. The choice of vasoactive and inotropic supportvaries among centers and may be guided by data arising from monitoring, but the following caveats may be observed:
– the vasodilator effects of dobutamine may lead to undesirable hypotension and tachycardia
pure vasopressors, like arginine vasopressin, are less likely to cause metabolic acidosis or pulmonary hypertension and may be a more appropriate than noradrenaline for the vasoplegic shock phase.
Despite these findings, recent guidelines advocate the addition of a standardized hormonal resuscitation package (a three drug “hormone resuscitation” or “combined hormonal therapy”) to the
standard management protocol consisting of methylprednisolone (15 mg/kg in a single intravenous bolus) or low dose hydrocortisone (50 mge.v. q6h), a triiodothyronine (4 μg bolus intra-
venously followed by infusion of 3 μg/h), and arginine vasopressin (1 U bolus infusion at 0.5 to 4U/h). The combined hormonal therapy is strongly recommended in donors assessed with a low
ejected fraction (<40%) or hemodynamic instability in full vasoactive support.
Currently available evidence in a large retrospective UNOS cohort study suggests a substantial benefit from triple hormone therapy with minimal risk. Specifically, a multivariate logistic regression analysis showed diminished requirements for vasoactive therapy and a significant increase in kidney, liver, and heart utilization in donors receiving “hormonal resuscitation”.
The main clinical reasons contributing to the lack of donor lungs are the use of suboptimal,under standardized critical care management and strict donor criteria of potential organ donors
Guidelines suggest that the priority for critical care management of potential organ donors should be shifted from a “cerebral protective” strategy to a strategy able to preserve peripheral organ function.
Our understanding of the pathophysiology of brain death and its effects on donor and recipient organ function has significantly progressed over the last two decades. Ultimately, attenuation of donor organ damage and improvement of post- transplant organ function will best be achieved by specifically targeting the unique systemic changes that occur after brain death. It seems likely that the key to such treatment will lie with protective management strategies. These therapies may be advanced by new insights into different aspects of emerging post mortem sciences including pharmacogenomic responsiveness, inflammation prevention, and biological modulation
http://www.ncbi.nlm.nih.gov/pubmed/19844809
http://link.springer.com/article/10....028-009-9292-y
Textbook of Neurointensive Care
2013, pp 895-917
Specific donor management goals have been established and have been associated with greater organ procurement. Hemodynamic management forms the cornerstone of brain-dead donor management
Vasopressors should be used to support acceptable blood pressure and hemodynamic profiles
A coordinated donor management approach utilizing intensivists and OPO coordinators has been shown to more effectively manage the donation process, resulting in more organs procured and transplanted.
http://link.springer.com/article/10....910-012-0272-9
Current Neurology and Neuroscience Reports
August 2012, Volume 12, Issue 4, pp 456-465
This has led to an increased focus within the critical care community on optimal identification and management of the potential organ donor. The multi-organ donor can represent one of the most complex intensive care patients, with numerous competing physiological priorities.
This review outlines current understandings of the physiological derangements seen in the organ donor and evaluates the available evidence for management strategies designed to optimize donation potential and organ recovery.
http://www.ncbi.nlm.nih.gov/pubmed/12243497
http://onlinelibrary.wiley.com/doi/1...2.20810.x/full
The reasons reported most often for not transplanting procured organs, or for not procuring organs from consented donors, are poor organ function and/or biopsy findings (1). Recently, both the technique (2) and the prognostic significance of certain pathological findings with kidney biopsies (3,4) have been reassessed, leaving poor organ function as the dominant reason for not transplanting consented organs. In fact, during the years 1995–2000, the number of consented kidneys that were not transplanted due to poor organ function was 1581 (2.4%) and the number of hearts was 5099 (17.2%).
The profound pathophysiological devastation associated with the sequelae of brain death (5,6) is of such magnitude that, in spite of conventional cardiopulmonary support, as many as 25% of potential donors may have a loss of perfusion to their organs, making them unsuitable for transplant before the organs can be retrieved (7). On the other hand, it has been shown that aggressive donor management, which may include pulmonary artery catheter monitoring and a combination of pharmacologic agents, can transform a significant number of donors with initially unacceptable cardiac function into acceptable and successful heart donors (8). All organs may benefit from aggressive management, and improved cardiac function can be expected to lead to an improvement in the function of all organs. Current evidence regarding the evaluation and management of potential cardiac donors led to the recommendation made at the Crystal City Consensus Conference (2001), that organ procurement organizations should use a standard protocol for donor management which includes increased application of pulmonary arterial catheterization (9). The need for this type of uniform, aggressive support of brain-dead potential organ donors to prevent cardiovascular collapse, inadequate organ perfusion, and organ loss has led to the further modification of a donor management critical pathway or algorithm.
Critical care staff were trained in the use of the pathway, and OPO staff collected data on each donor. Included in the data collected were: demographic information; time of brain death declaration, consent, and cross-clamp of the aorta in surgery; the number and type of organs consented for recovery; and the number and type of organs actually procured and transplanted. Similar retrospective data were extracted from a chart review of all organ donors from the participating units during the P-CP period.
One area where the Critical Pathway algorithm may be particularly useful is in small-volume hospitals that infrequently have cadaveric donor candidates (21). In that setting, the availability of the Critical Pathway may alert critical care personnel to the suitability of a potential donor, and allow those personnel to initiate initial diagnostic and management procedures while the organ procurement organization is notified and mobilized.
The third mechanism to increase the number of transplanted organs is to optimize donor management, with resultant increases in number of organs transplanted per donor. During this study, the Critical Pathway for the Organ Donor? was able to help meet the goal of increasing the number of organs available through optimum donor management.
Many health-care professionals have recognized the potential value of a standard donor management algorithm to enhance donation outcomes. As a result, the American Society of Transplant Surgeons, the American Society of Transplantation, the North American Transplant Coordinators Organization, and the Association of Organ Procurement Organizations, have endorsed the Critical Pathway for the Organ Donor?
The information looks tl;dr, but it is great info!
It backs up my education, training, and work experience in managing a brain dead patient.
Hope you all enjoy the reading!
There are currently 1 users browsing this thread. (0 members and 1 guests)
Posting Permissions
Reply With Quote
