Actualización de las recomendaciones para el tratamiento del donante cadavérico adulto y pediátrico luego de la muerte encefálica. Una Revisión Narrativa
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Palabras clave

cuidados críticos
donación de órganos
muerte encefálica
trasplante
unidad de cuidados intensivos

Cómo citar

1.
Rocchetti NS, Centeno P, Cyunel MJ, Farquharson C, Juri JC, Moreno MC, Poliszuk J, Santillán JE, Tarditti AA. Actualización de las recomendaciones para el tratamiento del donante cadavérico adulto y pediátrico luego de la muerte encefálica. Una Revisión Narrativa. Rev Arg de Ter Int. [Internet]. 19 de junio de 2020 [citado 31 de octubre de 2020];. Disponible en: //revista.sati.org.ar/index.php/MI/article/view/689

Resumen

El objetivo de esta revisión es proporcionar una visión general práctica y crítica de las intervenciones generales y aspectos específicos del tratamiento del potencial donante de órganos cadavérico luego de la muerte encefálica (ME), de manera que aumenten las posibilidades de un trasplante exitoso. Para eso, miembros del Comité de Trasplante y Procuración de Órganos y Tejidos de la Sociedad Argentina de Terapia Intensiva abordan siete áreas sobre la temática, realizando una revisión narrativa de cada apartado. La mayoría de las recomendaciones enunciadas se basan en la extrapolación de evidencias sobre el manejo general de pacientes en unidades de cuidados intensivos, o en razonamientos fisiopatológicos específicos de la ME. Esto se debe a la falta de ensayos controlados y aleatorizados sobre la temática, que generen evidencia sólida para el tratamiento óptimo de los mismos. Por lo que debería alentarse la investigación por ese camino, para así comprender mejor la fisiopatología y las medidas de tratamiento correctas en los potenciales donantes, que nos permitan optimizar el empleo de los órganos para trasplante.
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Citas

1. Coll E, Miranda B, Dominguez-Gil B, Martin E, Valentin M, Garrido G, et al. [Organ donors in Spain: evolution of donation rates per regions and determinant factors]. Med Clin (Barc). 2008;131:52-9.
2. Rocchetti NS, Rodriguez-Rodriguez A, Egea-Guerrero JJ. Tools for the early identification of patients who progress to brain death: seen from the vantage of emergency department staff. Emergencias. 2019;31:435-7.
3. Schrader H, Hall C, Zwetnow NN. Effects of prolonged supratentorial mass expansion on regional blood flow and cardiovascular parameters during the Cushing response. Acta Neurol Scand. 1985;72:283-94.
4. van Loon J, Shivalkar B, Plets C, Goffin J, Tjandra-Maga TB, Flameng W. Catecholamine response to a gradual increase of intracranial pressure. J Neurosurg. 1993;79:705-9.
5. 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 Med. 2019;45:343-53.
6. Novitzky D, Rhodin J, Cooper DK, Ye Y, Min KW, DeBault L. Ultrastructure changes associated with brain death in the human donor heart. Transpl Int. 1997;10:24-32.
7. Audibert G, Charpentier C, Seguin-Devaux C, Charretier PA, Gregoire H, Devaux Y, et al. Improvement of donor myocardial function after treatment of autonomic storm during brain death. Transplantation. 2006;82:1031-6.
8. Chamorro-Jambrina C, Munoz-Ramirez MR, Martinez-Melgar JL, Perez-Cornejo MS. Organ donor management: Eight common recommendations and actions that deserve reflection. Med Intensiva. 2017;41:559-68.
9. 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. Crit Care Med. 2015;43:1291-325.
10. Lazzeri C, Guetti C, Migliaccio ML, Ciapetti M, Peris A. The utility of serial echocardiograms for organ procurement in brain death. Clin Transplant. 2017;31.
11. Al-Khafaji A, Elder M, Lebovitz DJ, Murugan R, Souter M, Stuart S, et al. Protocolized fluid therapy in brain-dead donors: the multicenter randomized MOnIToR trial. Intensive Care Med. 2015;41:418-26.
12. Ramos HC, Lopez R. Critical care management of the brain-dead organ donor. Curr Opin Organ Transplant. 2002;7:70-5.
13. Tullius SG, Rabb H. Improving the Supply and Quality of Deceased-Donor Organs for Transplantation. N Engl J Med. 2018;378:1920-9.
14. Westphal GA, Caldeira Filho M, Fiorelli A, Vieira KD, Zaclikevis V, Bartz M, et al. Guidelines for maintenance of adult patients with brain death and potential for multiple organ donations: the Task Force of the Brazilian Association of Intensive Medicine the Brazilian Association of Organs Transplantation, and the Transplantation Center of Santa Catarina. Transplant Proc. 2012;44:2260-7.
15. Minambres E, Ballesteros MA, Rodrigo E, Garcia-Miguelez A, Llorca J, Ruiz JC, et al. Aggressive lung donor management increases graft procurement without increasing renal graft loss after transplantation. Clin Transplant. 2013;27:52-9.
16. Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012;367:1901-11.
17. Patel MS, Niemann CU, Sally MB, 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. Am J Transplant. 2015;15:2152-8.
18. Kucewicz E, Wojarski J, Zeglen S, Saucha W, Maciejewski T, Pacholewicz J, et al. [The protocol for multi organ donor management]. Anestezjol Intens Ter. 2009;41:246-52.
19. Schnuelle P, Gottmann U, Hoeger S, Boesebeck D, Lauchart W, Weiss C, et al. Effects of donor pretreatment with dopamine on graft function after kidney transplantation: a randomized controlled trial. JAMA. 2009;302:1067-75.
20. Birtan D, Arslantas MK, Altun GT, Dincer PC, Gecegormez S, Demirel A, et al. Effect of Vasoactive Therapy Used for Brain-Dead Donors on Graft Survival After Kidney Transplantation. Transplant Proc. 2018;50:1289-91.
21. Yoshioka T, Sugimoto H, Uenishi M, Sakamoto T, Sadamitsu D, Sakano T, et al. Prolonged hemodynamic maintenance by the combined administration of vasopressin and epinephrine in brain death: a clinical study. Neurosurgery. 1986;18:565-7.
22. Powner DJ, Darby JM, Kellum JA. Proposed treatment guidelines for donor care. Prog Transplant. 2004;14:16-26; quiz 7-8.
23. Del Rio F, Escudero D, De La Calle B, Vidal FG, Paredes MV, Nunez JR. [Evaluation and maintenance of the lung donor]. Med Intensiva. 2009;33:40-9.
24. Tibballs J. A critique of the apneic oxygenation test for the diagnosis of "brain death". Pediatr Crit Care Med. 2010;11:475-8.
25. Scott JB, Gentile MA, Bennett SN, Couture M, MacIntyre NR. Apnea testing during brain death assessment: a review of clinical practice and published literature. Respir Care. 2013;58:532-8.
26. Minambres E, Coll E, Duerto J, Suberviola B, Mons R, Cifrian JM, et al. Effect of an intensive lung donor-management protocol on lung transplantation outcomes. J Heart Lung Transplant. 2014;33:178-84.
27. Minambres E, Perez-Villares JM, Chico-Fernandez M, Zabalegui A, Duenas-Jurado JM, Misis M, et al. Lung donor treatment protocol in brain dead-donors: A multicenter study. J Heart Lung Transplant. 2015;34:773-80.
28. Venkateswaran RV, Dronavalli V, Patchell V, Wilson I, Mascaro J, Thompson R, et al. Measurement of extravascular lung water following human brain death: implications for lung donor assessment and transplantation. Eur J Cardiothorac Surg. 2013;43:1227-32.
29. Gramm HJ, Meinhold H, Bickel U, Zimmermann J, von Hammerstein B, Keller F, et al. Acute endocrine failure after brain death? Transplantation. 1992;54:851-7.
30. Howlett TA, Keogh AM, Perry L, Touzel R, Rees LH. Anterior and posterior pituitary function in brain-stem-dead donors. A possible role for hormonal replacement therapy. Transplantation. 1989;47:828-34.
31. Goarin JP, 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. Anesth Analg. 1996;83:41-7.
32. Novitzky D, Mi Z, Sun Q, Collins JF, Cooper DK. Thyroid hormone therapy in the management of 63,593 brain-dead organ donors: a retrospective analysis. Transplantation. 2014;98:1119-27.
33. Orlowski JP. Evidence that thyroxine (T-4) is effective as a hemodynamic rescue agent in management of organ donors. Transplantation. 1993;55:959-60.
34. Dimopoulou I, Tsagarakis S, Anthi A, Milou E, Ilias I, Stavrakaki K, et al. High prevalence of decreased cortisol reserve in brain-dead potential organ donors. Crit Care Med. 2003;31:1113-7.
35. Fisher AJ, Donnelly SC, Hirani N, Burdick MD, Strieter RM, Dark JH, et al. Enhanced pulmonary inflammation in organ donors following fatal non-traumatic brain injury. Lancet. 1999;353:1412-3.
36. Pinsard M, Ragot S, Mertes PM, Bleichner JP, Zitouni S, Cook F, et al. Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study. Crit Care. 2014;18:R158.
37. Dupuis S, Amiel JA, Desgroseilliers M, Williamson DR, Thiboutot Z, Serri K, et al. Corticosteroids in the management of brain-dead potential organ donors: a systematic review. Br J Anaesth. 2014;113:346-59.
38. Venkateswaran RV, Steeds RP, Quinn DW, Nightingale P, Wilson IC, Mascaro JG, et al. The haemodynamic effects of adjunctive hormone therapy in potential heart donors: a prospective randomized double-blind factorially designed controlled trial. Eur Heart J. 2009;30:1771-80.
39. Marvin MR, Morton V. Glycemic control and organ transplantation. J Diabetes Sci Technol. 2009;3:1365-72.
40. Hergenroeder GW, Ward NH, Yu X, Opekun A, Moore AN, Kozinetz CA, et al. Randomized trial to evaluate nutritional status and absorption of enteral feeding after brain death. Prog Transplant. 2013;23:374-82.
41. Carrot P, Cherry-Bukowiec JR, Jones JM, Miller KR, Kiraly L. Nutrition Therapy in the Organ Donor: Theoretical Benefits and Barriers to Implementation. Curr Nutr Rep. 2016;5:199-203.
42. Gil-Salazar T, Egea-Guerrero JJ, Martin-Villen L, Ruiz de Azua-Lopez Z. Organ donor management: Common recommendations that deserve evidence. Med Intensiva. 2018;42:513.
43. Powner DJ, Kellum JA, Darby JM. Abnormalities in fluids, electrolytes, and metabolism of organ donors. Prog Transplant. 2000;10:88-94; quiz 5-6.
44. Muhlberg J, Wagner W, Rohling R, Link J, Nuemeyer HH. Hemodynamic and metabolic problems in preparation for organ donation. Transplant Proc. 1986;18:391-3.
45. Maciel CB, Greer DM. ICU Management of the Potential Organ Donor: State of the Art. Curr Neurol Neurosci Rep. 2016;16:86.
46. Keren G, Barzilay Z, Schreiber M, Szienberg A, Aladjem M. Diabetes insipidus indicating a dying brain. Crit Care Med. 1982;10:798-9.
47. Plurad DS, Bricker S, Neville A, Bongard F, Putnam B. Arginine vasopressin significantly increases the rate of successful organ procurement in potential donors. Am J Surg. 2012;204:856-60; discussion 60-1.
48. Youn TS, Greer DM. Brain death and management of a potential organ donor in the intensive care unit. Crit Care Clin. 2014;30:813-31.
49. Adrogue HJ, Madias NE. Aiding fluid prescription for the dysnatremias. Intensive Care Med. 1997;23:309-16.
50. Figueras J, Busquets J, Grande L, Jaurrieta E, Perez-Ferreiroa J, Mir J, et al. The deleterious effect of donor high plasma sodium and extended preservation in liver transplantation. A multivariate analysis. Transplantation. 1996;61:410-3.
51. Gonzalez FX, Rimola A, Grande L, Antolin M, Garcia-Valdecasas JC, Fuster J, et al. Predictive factors of early postoperative graft function in human liver transplantation. Hepatology. 1994;20:565-73.
52. Wood KE, Becker BN, McCartney JG, D'Alessandro AM, Coursin DB. Care of the potential organ donor. N Engl J Med. 2004;351:2730-9.
53. Lansdale M, Gropper MA. Management of the Potential Organ Donor in the ICU. ICU Director. 2012;3:185-8.
54. Westphal GA. A simple bedside approach to therapeutic goals achievement during the management of deceased organ donors--An adapted version of the "VIP" approach. Clin Transplant. 2016;30:138-44.
55. Nueva Ley de Donación y Trasplante. Argentina. URL: https://www.argentina.gob.ar/salud/incucai/nueva-ley-de-doncacion-y-trasplante [15.12.19].
56. Niemann CU, Feiner J, Swain S, Bunting S, Friedman M, Crutchfield M, et al. Therapeutic Hypothermia in Deceased Organ Donors and Kidney-Graft Function. N Engl J Med. 2015;373:405-14.
57. Schnuelle P, Mundt HM, Druschler F, Schmitt WH, Yard BA, Kramer BK, et al. Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation. Am J Transplant. 2018;18:704-14.
58. Hahnenkamp K, Bohler K, Wolters H, Wiebe K, Schneider D, Schmidt HH. Organ-Protective Intensive Care in Organ Donors. Dtsch Arztebl Int. 2016;113:552-8.
59. Conrick-Martin I, Gaffney A, Dwyer R, O'Loughlin C, Colreavy F, Intensive Care Society of I. Intensive Care Society of Ireland - Guidelines for management of the potential organ donor (2018-2nd edition). Ir J Med Sci. 2019;188:1111-8.
60. Hebert PC, Wells G, Martin C, Tweeddale M, Marshall J, Blajchman M, et al. Variation in red cell transfusion practice in the intensive care unit: a multicentre cohort study. Crit Care. 1999;3:57-63.
61. Coberly EA, Booth GS. Ten-year retrospective review of transfusion practices in beating-heart organ donors. Transfusion. 2016;56:339-43.
62. de la Cruz JS, Sally MB, Zatarain JR, Crutchfield M, Ramsey K, Nielsen J, et al. The impact of blood transfusions in deceased organ donors on the outcomes of 1,884 renal grafts from United Network for Organ Sharing Region 5. J Trauma Acute Care Surg. 2015;79:S164-70.
63. Lisman T, Leuvenink HG, Porte RJ, Ploeg RJ. Activation of hemostasis in brain dead organ donors: an observational study. J Thromb Haemost. 2011;9:1959-65.
64. Valdivia M, Chamorro C, Romera MA, Balandin B, Perez M. Effect of posttraumatic donor's disseminated intravascular coagulation in intrathoracic organ donation and transplantation. Transplant Proc. 2007;39:2427-8.
65. Garrouste C, Baudenon J, Gatault P, Pereira B, Etienne I, Thierry A, et al. No impact of disseminated intravascular coagulation in kidney donors on long-term kidney transplantation outcome: A multicenter propensity-matched study. Am J Transplant. 2019;19:448-56.
66. Dictus C, Vienenkoetter B, Esmaeilzadeh M, Unterberg A, Ahmadi R. Critical care management of potential organ donors: our current standard. Clin Transplant. 2009;23 Suppl 21:2-9.
67. Cyunel M, Garea M, Neira P. [Procurement and Transplantation of Organs and Tissues]. Rev Hosp Niños (B Aires). 2019;61:88-94.
68. Bonetto G, Taffarel P, Gamerman M, Jorro Baron F, Gavina C, Flores L, et al. Brain death and organ donation in Argentine pediatric intensive care units. A multicenter study. Arch Argent Pediatr. 2018;116:e54-e60.
69. Association AH. Apartado 3: Enfoque sistemático para tratar a un niños con enfermedades o lesiones graves. In: Association AH, editor. Soporte Vital Avanzado Pediátrico Libro del Proveedor. Texas, Estados Unidos: American Heart Association; 2017.
70. Ream RS, Clark MG, Armbrecht ES. Pediatric Donor Management Goals in Use by US Organ Procurement Organizations. Prog Transplant. 2019;29:150-6.
71. Lutz-Dettinger N, de Jaeger A, Kerremans I. Care of the potential pediatric organ donor. Pediatr Clin North Am. 2001;48:715-49.
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