Journal article : Review
Optimisation of the organ donor and effects on transplanted organs: a narrative review on current practice and future directions
- Abstract:
- Mortality remains high for patients on the waiting list for organ transplantation. A marked imbalance between the number of available organs and recipients that need to be transplanted persists. Organs from deceased donors are often declined due to perceived and actual suboptimal quality. Adequate donor management offers an opportunity to reduce organ injury and maximise the number of organs than can be offered in order to respect the donor's altruistic gift. The cornerstones of management include: correction of hypovolaemia; maintenance of organ perfusion; prompt treatment of diabetes insipidus; corticosteroid therapy; and lung protective ventilation. The interventions used to deliver these goals are largely based on pathophysiological rationale or extrapolations from general critical care patients. There is currently insufficient high-quality evidence that has assessed whether any interventions in the donor after brain death may actually improve immediate post-transplant function and long-term graft survival or recipient survival after transplantation. Improvements in our understanding of the underlying mechanisms following brain death, in particular the role of immunological and metabolic changes in donors, offer promising future therapeutic opportunities to increase organ utilisation. Establishing a UK donor management research programme involves consideration of ethical, logistical and legal issues that will benefit transplanted patients while respecting the wishes of donors and their families.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 2.4MB, Terms of use)
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- Publisher copy:
- 10.1111/anae.15037
Authors
- Publisher:
- Wiley
- Journal:
- Anaesthesia More from this journal
- Volume:
- 75
- Issue:
- 9
- Pages:
- 1191-1204
- Publication date:
- 2020-05-19
- Acceptance date:
- 2020-03-05
- DOI:
- EISSN:
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1365-2044
- ISSN:
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0003-2409
- Pmid:
-
32430910
- Language:
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English
- Keywords:
- Subtype:
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Review
- Pubs id:
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1106008
- Local pid:
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pubs:1106008
- Deposit date:
-
2020-05-25
- ARK identifier:
Terms of use
- Copyright holder:
- Bera et al.
- Copyright date:
- 2020
- Rights statement:
- © 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
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