Organ donation

Learning objectives

Specify the adverse effects on organs after the diagnosis of death
Describe the active management of the donor’s physiology to optimize the quality of organs donated
Outline the associated anesthesia interventions

Organ donation and transplantation is removing an organ from one person (the donor) and surgically placing it in another (the recipient) whose organ has failed
Death can be diagnosed by somatic, circulatory, and neurological criteria
DBD: Donation after Brain Death
- At least 2 physicians must declare brain death
DCD: Donation after Cardiac Death
- A DCD donor has suffered a severe non-recoverable brain insult
- DCD donor’s death is declared based on cardiopulmonary criteria after withdrawal of life support
- Organ procurement can only start 5 minutes after death is declared

Parameter	Target
Heart rate	60-120 beats/min
Arterial pressure	Systolic pressure > 100 mmHg Mean pressure ≥ 70 mmHg
Central venous pressure	6-10 mmHg
Urine output	0.5-3 ml/kg/h
Electrolytes	Serum sodium 130-150 mmol/L Normal potassium, calcium, magnesium, phosphate Glucose 4-8 mmol/L
Blood gases	pH 7.35-7.45 PaCO2 4.7-6 kPa PaO2 ≥ 10.7 kPa SPO2 saturation > 95%
Pulmonary capillary wedge pressure	6-10 mmHg
Cardiac index	2.4 L/min/m
Systemic vascular resistance	800-1200 dyn/s/cm