Organ donation: a 10-year experience

Introduction

There is a growing disparity between patients placed on a waiting list and those who are transplanted, and the number of patients who die while on a waiting list is also increasing. A 10-year retrospective chart review was performed on all organ donors to define our current practice in order to propose initiatives to increase our organ donor rate.

Results

Seventy-seven charts were reviewed; mean age of donors was 47 ± 16 years (range 16–82). A vascular accident (77%) was the most common etiology of brain death. An organ donor management protocol had not been developed. The majority of patients (87%) had central venous pressure monitoring; only 21% patients had a pulmonary artery catheter. Complications included diabetes insipidus (DI) (74%), hypotension requiring inotropic/ vasoconstrictor support (88%) and hypothermia (100%) requiring active warming measures; 9/10 patients who had no invasive pressure monitoring were receiving inotropic support. The majority of patients (47%) had an abnormal serum sodium with hypernatremia as the most common abnormality. The mean number of organs donated per donor was 3.29 ± 1.21; the kidney was the most utilized (87%), followed by the liver (73%), heart (44%), lung (18%), pancreas (8%) and intestine (1%). As the number of inotropic support medications increased, there was a tendency for the mean number of organs donated per donor to decrease (P = 0.1; Table 1).

Table 1

Conclusions

Without an organ donor management protocol, there was a considerable variation in the management of our organ donors. Hypotension, DI and electrolyte disturbances were common complications and many patients required fluid resuscitation and inotropic support as well as pharmacological treatment for DI. With the institution of an organ donor management protocol that includes the administration of triple hormonal therapy (thyroxine, vasopressin, glucocorticoid), we have begun a prospective study to determine the impact of an organ donor management protocol on organ donor complication rate, the need for inotropic support and whether this will result in an increase of number of organs per donor transplanted.