Related Experiment Videos
Intensive care management of paediatric organ donors and its effect on post-transplant organ function
1Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Pediatric organ donor management, including aggressive fluid resuscitation and diabetes insipidus treatment, can improve donor stability. Donor cardiac arrest does not negatively impact post-transplant organ function, challenging current donor selection criteria.
Area of Science:
- Pediatric critical care medicine
- Organ transplantation
- Nephrology
- Hepatology
- Cardiology
Background:
- Paediatric organ donation presents unique challenges in maintaining physiological stability.
- Optimizing intensive care unit (ICU) management is crucial for preserving organ viability.
- Current donor selection criteria may not fully predict post-transplant outcomes.
Purpose of the Study:
- To document the clinical course of paediatric beating heart organ donors.
- To evaluate the impact of ICU management on the immediate function of transplanted paediatric organs.
- To assess the predictive validity of existing donor selection criteria.
Main Methods:
- Retrospective chart review and case series study.
- Involved multidisciplinary intensive care unit (ICU) management in a tertiary referral paediatric hospital.
- Analyzed data from paediatric patients who became solid organ donors between 1980 and 1990.
Main Results:
- Seventy-seven paediatric donors yielded 134 kidneys, 31 livers, and 12 hearts for transplantation.
- Sixty percent of donors experienced major physiological derangements, including hypotension and diabetes insipidus.
- Donor cardiac arrest did not adversely affect immediate post-transplant organ function in kidneys, livers, or hearts.
Conclusions:
- Aggressive fluid resuscitation and diabetes insipidus management are vital for paediatric donor stability.
- Donor cardiac arrest is not a contraindication for organ transplantation and does not compromise immediate graft function.
- Current donor selection criteria are insufficient for predicting post-transplant organ function, potentially leading to increased organ wastage.
Objectives:
1. To document the clinical course of paediatric beating heart organ donors. 2. To evaluate the effect of the ICU management of pediatric donors on the immediate function of transplanted organs. 3. To examine the validity of current donor selection criteria.
Design:
Retrospective chart review and case series study.
Setting:
Multidisciplinary ICU of tertiary referral paediatric hospital.
Patients:
All patients who became solid organ donors between January 1980 and July 1990.
Outcome Measures:
1. Incidence of major physiological abnormalities of the cardiovascular, pulmonary, renal and metabolic systems. 2. Number of organs retrieved and transplanted, reasons for non-transplantation of donated organs. 3. Immediate post-transplant function of transplanted organs.
Results:
Seventy-seven organ donors were identified from whom 134 kidneys, 31 livers and 12 hearts were transplanted. Sixty (78%) patients developed diabetes insipidus. Sustained hypotension occurred in 41 (53.2%) and was commoner in patients treated with inotropic agents in the presence of a low central venous pressure and in patients with diabetes insipidus who did not receive anti-diuretic hormone replacement. Twenty-seven patients suffered at least one cardiac arrest. The data on post-transplant function were obtained for 129 kidneys (from 70 donors) 30 livers and 9 hearts. Fifty-two kidneys, 10 livers and 2 hearts were transplanted from donors who had suffered at least one cardiac arrest without apparent adverse effect on post-transplant organ function. Thirty-six kidneys from 31 donors suffered either acute tubular necrosis (ATN) or primary non-function. The donors of these organs spent longer in ICU (60.6 +/- 45.7 h versus 41.8 +/- 30.1 h p = 0.045) and had a higher mean maximum serum sodium concentration (163.4 +/- 10.9 versus 158.5 +/- 9.5 mmol/l p = 0.05) than those without these complications. The serum creatinine concentration and degree of inotropic support did not predict post-transplant function. Standard biochemical tests for hepatic function, the dose of inotropic agent received, time in ICU and incidence of hypotension did not predict post-transplant liver function.
Conclusions:
Aggressive fluid resuscitation and management of diabetes insipidus may promote stability in paediatric organ donors. Donor cardiac arrest does not alter the ICU course or compromise post-transplant organ function. The current criteria used for donor selection failed to predict post-transplant organ function and their use may increase organ wastage.