Donor Management Principles

Optimal management of the haemodynamic, metabolic, and respiratory status of the donor is essential in order to maximise the yield of suitable thoracic donor organs.7 Specifically, this has been advocated by the group at Papworth Hospital in Cambridge, UK.w43 Brain death is associated with an "autonomic and cytokine storm". The release of noradrenaline (norepinephrine) leads to subendocardial ischaemia. Subsequent cytokine release results in further myocardial depression. This is accompanied by pronounced vasodilation and loss of temperature control. Vasodilation and myocardial depression are compounded by changes in volume status, specifically by relative hypovolaemia which is usually a consequence of aggressive diuretic treatment used to minimise donor cerebral oedema. Optimal donor haemodynamic management includes a pulmonary artery catheter to achieve the goals of euvolaemia and normal cardiac output, minimising the use of a agonists.8 Metabolic management aims at correcting

Table 7.5

Effect of denervation

on cardiac

pharmacology

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