Anesthetic optimization for nonheartbeating donors

One of the newest strategies to enlarge the pool of organ donors is to consider the category of donors after cardiac death rather than only after brain death. Prompt and accurate identification of potential donors and appropriate care is necessary to optimize the management of nonheartbeating donors.

Organ procurement derived from donors after cardiac death is becoming a part of the policy of major transplantation hospitals, forcing them to consider the practical interventions and ethical implications regarding this practice. Typical donors are patients affected by irreversible brain injuries, high spinal cord injury and end-stage musculoskeletal diseases. To start the process the following three conditions must be met. Withdrawal of life-sustaining therapies must be considered independently from transplantation. Withdrawal of life support requires a careful titration of the drugs controlling pain, anxiety and discomfort. Organ harvesting has to be initiated after at least 2-5 min of confirmed cardiac death.

In order to increase the number of organs available for transplantation, donation from nonheartbeating donors has been recently proposed. Identification of the key aspects of the donation after cardiac death should be fully achieved by the team involved in the transplantation program. Development of hospital policies and identification of receivers who are most likely to benefit from this strategy require further studies to assess long-term outcome and to identify ethical aspects concerning different religious and cultural backgrounds.