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World J Meta-Anal. Feb 28, 2021; 9(1): 51-53
Published online Feb 28, 2021. doi: 10.13105/wjma.v9.i1.51
Should we use full analgesic dose of opioids for organ procurement in brainstem dead?
Philippe Charlier, John-David Rebibo, Nadia Benmoussa
Philippe Charlier, Nadia Benmoussa, Laboratory Anthropology, Archaeology, Biology (LAAB), Paris-Saclay University, Montigny-Le-Bretonneux 78180, France
John-David Rebibo, Department of Urology, Hôpital Privé Armand Brillard, Nogent-sur-Marne 94052, France
Nadia Benmoussa, Department of ENT, Gustave-Roussy Institute, Villejuif 94805, France
Author contributions: Charlier C wrote the first draft of the manuscript with significant critical input from Rebibo JD and Benmoussa N.
Conflict-of-interest statement: None for any of all authors.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Philippe Charlier, DPhil, MD, PhD, Assistant Professor, Director, Laboratory Anthropology, Archaeology, Biology, Paris-Saclay University, 2 avenue de la Source de la Bièvre, Montigny-Le-Bretonneux 78180, France. philippe.charlier@uvsq.fr
Received: December 27, 2020
Peer-review started: December 27, 2020
First decision: January 25, 2021
Revised: January 30, 2021
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: February 28, 2021
Processing time: 65 Days and 0.1 Hours
Abstract

Families facing the growing demand for organ removal from their loved ones are questioning the possible suffering of the brainstem dead patient. A frequent question they ask to coordinating doctors is: Are you sure he will not feel anything? Currently due to the risk of exacerbation of spinal reflexes and abnormal movements following surgical stimuli, it is recommended to use a curarization and an analgesic agent (most often morphine). The doses of opioids are less important than during usual anaesthesia, whereas the person is considered brainstem dead and there is no longer any cerebral integration of the pain. But what assures us that absolutely no more sensibility exists at this precise moment? Should the use of full analgesic dose of opioids not be continued anyway? Could this make the levies more "ethical"?

Keywords: Bioethics; Transplantation; Anaesthesiology; Brainstem dead

Core Tip: Families facing the growing demand for organ removal from their loved ones are questioning the possible suffering of the brainstem dead patient. A frequent question they ask to coordinating doctors is: Are you sure he will not feel anything? Currently due to the risk of exacerbation of spinal reflexes and abnormal movements following surgical stimuli, it is recommended to use a curarization and an analgesic agent (most often morphine). The doses of opioids are less important than during usual anaesthesia, whereas the person is considered brainstem dead and there is no longer any cerebral integration of the pain. But what assures us that absolutely no more sensibility exists at this precise moment? We propose that further neuroscientific analyses be conducted in order to improve our knowledge about such a sensibility. We ask to the medical community if we should rather use full analgesic dose of opioids, and question if this would make the levies more "ethical"?