Lazzeri C, Bonizzoli M, Batacchi S, Guetti C, Vessella W, Valletta A, Ottaviano A, Peris A. Haemodynamic management in brain death donors: Influence of aetiology of brain death. World J Transplant 2023; 13(4): 183-189 [PMID: 37388386 DOI: 10.5500/wjt.v13.i4.183]
Corresponding Author of This Article
Chiara Lazzeri, MD, Chief Physician, Senior Researcher, Department of Emergency, Intensive Care Unit and Extracorporeal Membrane Oxygenation Center, Largo Brambilla 3, Florence 50134, Italy. lazzeri.ch@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Chiara Lazzeri, Manuela Bonizzoli, Stefano Batacchi, Cristiana Guetti, Walter Vessella, Alessandra Valletta, Alessandra Ottaviano, Adriano Peris, Department of Emergency, Intensive Care Unit and Extracorporeal Membrane Oxygenation Center, Florence 50134, Italy
Author contributions: Lazzeri C, Bonizzoli M, and Peris A designed the research study; Guetti C, Batacchi S, and Ottaviano A performed the research; Valletta A and Vessella W analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study protocol was approved by our Internal Editorial Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chiara Lazzeri, MD, Chief Physician, Senior Researcher, Department of Emergency, Intensive Care Unit and Extracorporeal Membrane Oxygenation Center, Largo Brambilla 3, Florence 50134, Italy. lazzeri.ch@gmail.com
Received: December 20, 2022 Peer-review started: December 20, 2022 First decision: February 20, 2023 Revised: February 28, 2023 Accepted: April 21, 2023 Article in press: April 21, 2023 Published online: June 18, 2023
ARTICLE HIGHLIGHTS
Research background
In brain death donors (BDDs), donor management is the key in the complex donation process. Donor management goals, which are standards of care or clinical parameters, have been considered an acceptable barometer of successful donor management.
Research motivation
Meeting donor management goals has been associated with an increased number of retrieved organs per donor and, more recently, a reduced incidence of delayed graft function.
Research objectives
To test the hypothesis that aetiology of brain death could influence haemodynamic management in BDDs.
Research methods
Haemodynamic data (blood pressure, heart rate, central venous pressure, lactate, urine output, and vasoactive drugs) were recorded on intensive care unit (ICU) admission and during the 6-h observation period (Time 1 at the beginning; Time 2 at the end).
Research results
The study population was divided three groups according to aetiology of brain death: Stroke (n = 71), traumatic brain injury (n = 48), and postanoxic encephalopathy (n = 19). On ICU admission, BDDs with postanoxic encephalopathy showed the lowest values of SBP and DBP associated with higher values of heart rate and lactate and a higher need of norepinephrine and other vasoactive drugs. At the beginning of the 6-h period (Time 1), BDDs with postanoxic encephalopathy showed higher values of heart rate, lactate, and central venous pressure together with a higher need of other vasoactive drugs.
Research conclusions
According to our data, haemodynamic donor management is affected by the aetiology of brain death. BDDs with postanoxic encephalopathy have higher requirements for norepinephrine and other vasoactive drugs.
Research perspectives
Our data underscore the utility of the relevant data on potential organ donors being reported to a national registry and how this can be used to drive practice improvement and eventually to develop consensus statements.
