Abstract
The number of people awaiting organ transplantation continues to exceed the number of organs available for transplantation, especially at a time when kidney transplantation is recognized as the best treatment option for end stage renal disease. There may be many reasons for this disparity of organ supply and demand, including the lack of consent, absence of an experienced coordinator team to help in closing the widening gap between organ supply and demand, and an unstandardized critical care management of potential organ donors. According to the report of the Korean Organ Transplant Registry in March 2014, due to a serious organ shortage in Korea, kidneys of deceased donors with low initial estimated glomerular filtration rate of <45 mL/min/1.73 m2 (21.2%) and expanded criteria donors (18.3%) are frequently used, and the number of wife donors and ABO-incompatible transplants for blood type O recipients is increasing. Because the number of donor organs compared with the demand is very restricted, proper management of deceased donors in the intensive care unit has been recognized as a critical determinant for a successful transplantation. Therefore, for successful transplantation of harvested organs, many medical doctors who play an integral role in the transplantation process should understand the pathophysiology of brain death-related systemic changes and well-designed management guidelines should be used prior to transplantation of deceased donors. This article reports on brain death-related systemic changes and proper management for preservation of function of donor organs.
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Fig. 3.
Protocol for aggressive donor management. Abbreviations: ICU, intensive care unit; MAP, mean arterial pressure; SIADH, syndrome of inappropriate secretion of antidiuretic hormone.
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Table 1.
The criteria in determining of brain death in Korea
Table 2.
The guidelines of proper management of deceased donor