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HERO ID
9936059
Reference Type
Journal Article
Subtype
Review
Title
Controversial points in organ donor management
Author(s)
Chamorro, C; Falcón, JA; Michelena, JC
Year
2009
Is Peer Reviewed?
1
Journal
Transplantation Proceedings
ISSN:
0041-1345
EISSN:
1873-2623
Volume
41
Issue
8
Page Numbers
3473-3475
Language
English
PMID
19857774
DOI
10.1016/j.transproceed.2009.09.004
Abstract
There are still many controversial aspects regarding which method is best for managing organ donors to prevent, lessen, or even reverse the organ alterations associated with brain death. Fundamental aspects are the management of an adequate perfusion pressure, hormone restoration, and opposition of the inflammatory state associated with brain death. Once volume has been normalized, it is necessary to administer vasoactive drugs, including catecholamines to re-establish the loss of sympathetic tone at the vascular and myocardial level. It is impossible to define the ideal or maximal catecholamine dose because it depends on the donor's vascular tone, vascular reactivity, and pharmacokinetic variability characteristic of critical patients, particularly organ donors. To control early onset of diabetes insipidus, it is necessary to administer desmopressin. At present there are insufficient clinical studies to show the usefulness of triiodothyronine. Furthermore, due to its limited availability, elevated cost, and probable side effects, the use of this hormone is not justified. More importance is being given to the negative influence of the inflammatory state associated with brain death, which has repercussions on organ viability and probably influences the prevalence of rejection episodes. Meanwhile in organ donor management, we recommend the use of 15 mg/kg of methylprednisolone as soon as possible. Contrary to triiodothyronine, the potential benefit of its immunomodulatory effects, its low cost, and the absence of major side effects justify this recommendation.
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