Cardiac organ donor management

Sana Ullah, Luis Zabala, Bryan Watkins, Michael L. Schmitz

Research output: Contribution to journalArticle

25 Citations (Scopus)

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, methyl-prednisolone 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 and ventilation should be optimized. Recently, two large retrospective studies have shown that, with aggressive pharmacological and hormonal resuscitation, a significant increase in the number and quality of organs harvested can be achieved.

Original languageEnglish (US)
Pages (from-to)93-98
Number of pages6
JournalPerfusion
Volume21
Issue number2
DOIs
StatePublished - 2006

Fingerprint

Vasopressins
Resuscitation
Tissue Donors
Oxygen
Anaerobiosis
Diabetes Insipidus
Hypovolemia
Brain Death
Ventricular Function
Wounds and Injuries
Triiodothyronine
Prednisolone
management
Hypotension
Epinephrine
Ventilation
Echocardiography
Anemia
Shock
Dopamine

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac organ donor management. / Ullah, Sana; Zabala, Luis; Watkins, Bryan; Schmitz, Michael L.

In: Perfusion, Vol. 21, No. 2, 2006, p. 93-98.

Research output: Contribution to journalArticle

Ullah, S, Zabala, L, Watkins, B & Schmitz, ML 2006, 'Cardiac organ donor management', Perfusion, vol. 21, no. 2, pp. 93-98. https://doi.org/10.1191/0267659106pf851oa
Ullah, Sana ; Zabala, Luis ; Watkins, Bryan ; Schmitz, Michael L. / Cardiac organ donor management. In: Perfusion. 2006 ; Vol. 21, No. 2. pp. 93-98.
@article{636c2d7c41424d10b5f6beb88cb8139e,
title = "Cardiac organ donor management",
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, methyl-prednisolone 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 and ventilation should be optimized. Recently, two large retrospective studies have shown that, with aggressive pharmacological and hormonal resuscitation, a significant increase in the number and quality of organs harvested can be achieved.",
author = "Sana Ullah and Luis Zabala and Bryan Watkins and Schmitz, {Michael L.}",
year = "2006",
doi = "10.1191/0267659106pf851oa",
language = "English (US)",
volume = "21",
pages = "93--98",
journal = "Perfusion (United Kingdom)",
issn = "0267-6591",
publisher = "SAGE Publications Ltd",
number = "2",

}

TY - JOUR

T1 - Cardiac organ donor management

AU - Ullah, Sana

AU - Zabala, Luis

AU - Watkins, Bryan

AU - Schmitz, Michael L.

PY - 2006

Y1 - 2006

N2 - 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, methyl-prednisolone 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 and ventilation should be optimized. Recently, two large retrospective studies have shown that, with aggressive pharmacological and hormonal resuscitation, a significant increase in the number and quality of organs harvested can be achieved.

AB - 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, methyl-prednisolone 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 and ventilation should be optimized. Recently, two large retrospective studies have shown that, with aggressive pharmacological and hormonal resuscitation, a significant increase in the number and quality of organs harvested can be achieved.

UR - http://www.scopus.com/inward/record.url?scp=33645774966&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33645774966&partnerID=8YFLogxK

U2 - 10.1191/0267659106pf851oa

DO - 10.1191/0267659106pf851oa

M3 - Article

C2 - 16615686

AN - SCOPUS:33645774966

VL - 21

SP - 93

EP - 98

JO - Perfusion (United Kingdom)

JF - Perfusion (United Kingdom)

SN - 0267-6591

IS - 2

ER -