Donör Bakımı
Özet
Beyin ölümü, çoklu organ sistemlerini etkileyen, karmaşık değişikliklerle karakterize önemli bir patofizyolojik süreçtir. Bu karmaşık patofizyolojik durum sebebiyle organ nakli sürecinde donör bakımı kritik önem taşımaktadır. Bu süreçte kardiyovasküler, pulmoner, endokrin, renal, gastrointestinal ve hematolojik sistemlerde ciddi bozukluklar meydana gelebilir. Kardiyovasküler dengesizlikler, hipertansiyon-hipotansiyon, taşikardi-bradikardi atakları ile kendini gösterirken, pulmoner fonksiyonlar nörojenik pulmoner ödem nedeniyle kötüleşebilir. Endokrin sistemde hipotalamo-hipofizer yetmezlik nedeniyle hormonal dengesizlikler oluşabilir. Renal perfüzyonun azalması, böbrek fonksiyonlarını tehlikeye atabilirken, koagülopati ve inflamatuar yanıtlar hematolojik sistemde komplikasyonlara yol açabilir. Donör bakımında hemodinamik destek, sıvı yönetimi, hormonal tedavi ve ventilasyon stratejileri organ fonksiyonlarını korumak ve transplantasyon sonuçlarını optimize etmek için hayati öneme sahiptir. Bu sistemik değişikliklerin uygun şekilde yönetilmesi, organların canlılığını sürdürerek nakil başarısını artırabilir.
Brain death is an important pathophysiological process characterized by complex alterations affecting multiple organ systems. Due to this complex pathophysiologic state, donor care is critical during organ transplantation process. In this critical phase; cardiovascular, pulmonary, endocrine, renal, gastrointestinal and hematologic systems can be severely impaired. Cardiovascular imbalances may be manifested by hypertension-hypotension, tachycardia-bradycardia attacks, while pulmonary function may worsen due to neurogenic pulmonary edema. In the endocrine system, hormonal imbalances may occur due to hypothalamo-pituitary insufficiency. Decreased renal perfusion may compromise renal function, while coagulopathy and inflammatory responses may lead to severe hematological disorders. In donor care, hemodynamic support, fluid management, hormonal therapy and ventilation strategies are vital to preserve organ function and optimize transplantation outcomes. Appropriate management of these systemic changes may improve transplant success by maintaining organ viability.
Referanslar
Smith M. Physiologic changes during brain stem death—lessons for management of the organ donor. The Journal of heart and lung transplantation. 2004;23(9):S217-S22.
Wood KE, Becker BN, McCartney JG, D'Alessandro AM, Coursin DB. Care of the potential organ donor. New England Journal of Medicine. 2004;351(26):2730-9.
Drory Y, Ouaknine G, Kosary I, Kellermann J. Electrocardiographic findings in brain death; description and presumed mechanism. Chest. 1975;67(4):425-32.
Novitzky D, Rose A, Cooper D. Injury of myocardial conduction tissue and coronary artery smooth muscle following brain death in the baboon. Transplantation. 1988;45(5):964-6.
Novitzky D, Cooper DK, Rosendale JD, Kauffman HM. Hormonal therapy of the brain-dead organ donor: experimental and clinical studies. Transplantation. 2006;82(11):1396-401.
Goarin J-P, Cohen S, Riou B, Jacquens Y, Guesde R, Le Bret F, et al. The effects of triiodothyronine on hemodynamic status and cardiac function in potential heart donors. Anesthesia & Analgesia. 1996;83(1):41-7.
Busl KM, Bleck TP. Neurogenic pulmonary edema. Critical care medicine. 2015;43(8):1710-5.
McKeown D, Bonser R, Kellum J. Management of the heartbeating brain-dead organ donor. British journal of anaesthesia. 2012;108(suppl_1):i96-i107.
Kutsogiannis DJ, Pagliarello G, Doig C, Ross H, Shemie SD. Medical management to optimize donor organ potential: review of the literature. Canadian Journal of Anesthesia. 2006;53(8):820.
Lisman T, Leuvenink H, Porte R, Ploeg R. Activation of hemostasis in brain dead organ donors: an observational study. Journal of Thrombosis and Haemostasis. 2011;9(10):1959-65.
Fruhwald S, Holzer P, Metzler H. Gastrointestinal motility in acute illness. Wiener Klinische Wochenschrift. 2008;120.
Kotloff RM, Blosser S, Fulda GJ, Malinoski D, Ahya VN, Angel L, et al. Management of the potential organ donor in the ICU: society of critical care medicine/American college of chest physicians/association of organ procurement organizations consensus statement. Critical care medicine. 2015;43(6):1291-325.
Patel M, Niemann C, Sally M, De La Cruz S, Zatarain J, Ewing T, et al. The impact of hydroxyethyl starch use in deceased organ donors on the development of delayed graft function in kidney transplant recipients: a propensity‐adjusted analysis. American Journal of Transplantation. 2015;15(8):2152-8.
Birtan D, Arslantas MK, Altun GT, Dincer PC, Gecegormez S, Demirel A, et al., editors. Effect of vasoactive therapy used for brain-dead donors on graft survival after kidney transplantation. Transplantation Proceedings; 2018: Elsevier.
Stoica SC, Satchithananda DK, White PA, Parameshwar J, Redington AN, Large SR. Noradrenaline use in the human donor and relationship with load-independent right ventricular contractility. Transplantation. 2004;78(8):1193-7.
Hoeger S, Gottmann U, Liu Z, Schnuelle P, Birck R, Braun C, et al. Dopamine treatment in brain‐dead rats mediates anti‐inflammatory effects: the role of hemodynamic stabilization and D‐receptor stimulation. Transplant International. 2007;20(9):790-9.
Plurad DS, Bricker S, Neville A, Bongard F, Putnam B. Arginine vasopressin significantly increases the rate of successful organ procurement in potential donors. The American journal of surgery. 2012;204(6):856-61.
Pennefather SH, Bullock RE, Mantle D, Dark JH. Use of low dose arginine vasopressin to support brain-dead organ donors. Transplantation. 1995;59(1):58-62.
Schnuelle P, Yard B, Braun C, Dominguez-Fernandez E, Schaub M, Birck R, et al. Impact of donor dopamine on immediate graft function after kidney transplantation. American Journal of Transplantation. 2004;4(3):419-26.
Meyfroidt G, Gunst J, Martin-Loeches I, Smith M, Robba C, Taccone FS, et al. Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality. Intensive care medicine. 2019;45:343-53.
Kotsch K, Ulrich F, Reutzel-Selke A, Pascher A, Faber W, Warnick P, et al. Methylprednisolone therapy in deceased donors reduces inflammation in the donor liver and improves outcome after liver transplantation: a prospective randomized controlled trial. Annals of surgery. 2008;248(6):1042-50.
Salim A, Vassiliu P, Velmahos GC, Sava J, Murray JA, Belzberg H, et al. The role of thyroid hormone administration in potential organ donors. Archives of surgery. 2001;136(12):1377-80.
Gunst J, Souter MJ. Management of the brain-dead donor in the intensive care unit. Springer; 2024. p. 1-4.
Dupuis S, Amiel J-A, Desgroseilliers M, Williamson D, Thiboutot Z, Serri K, et al. Corticosteroids in the management of brain-dead potential organ donors: a systematic review. British journal of anaesthesia. 2014;113(3):346-59.
Marvin MR, Morton V. Glycemic control and organ transplantation. Journal of diabetes science and technology. 2009;3(6):1365-72.
Lewis A, Kirschen MP, Greer D. The 2023 AAN/AAP/CNS/SCCM pediatric and adult brain death/death by neurologic criteria consensus practice guideline: a comparison with the 2010 and 2011 guidelines. Neurology: Clinical Practice. 2023;13(6):e200189.
Coberly EA, Booth GS. Ten‐year retrospective review of transfusion practices in beating‐heart organ donors. Transfusion. 2016;56(2):339-43.
Singer P, Cohen J, Cynober L. Effect of nutritional state of brain-dead organ donor on transplantation. Nutrition. 2001;17(11-12):948-52.
Fishman JA, Greenwald MA, Grossi PA. Transmission of infection with human allografts: essential considerations in donor screening. Clinical infectious diseases. 2012;55(5):720-7.
Citerio G, Cypel M, Dobb GJ, Dominguez-Gil B, Frontera JA, Greer DM, et al. Organ donation in adults: a critical care perspective. Intensive Care Medicine. 2016;42:305-15.
