Organ donation. I--Management of the multiorgan donor.

Abstract

I -Management of the multiorgan donorShortage of donor organs is the main limiting factor in most types of transplantation.Over 3500 patients are currently awaiting kidney transplants in Britain, and nearly one third of patients accepted for heart trans- plants die before a suitable donor is found.Potential organ donors are often admitted to peripheral hospitals, where there may be little experience of the issues and problems.These hospitals may each see only one or two such patients a year, so there may be a natural reluctance to get embroiled in the complexities of organ donation.This article describes the management of the multi- organ donor in the hope that doctors not concerned in transplantation may be encouraged to identify potential donors and to participate in their management. Identification and assessment of potential donorsAny patient who is likely to remain permanently unconscious on life support as a result of intracerebral damage should be considered a potential organ donor.This must not influence medical management before brain death is declared, but it does enable subsequent events to proceed more smoothly and rapidly.The usual causes of brain death are trauma and intracranial haemorrhage.Less common causes are hypoxic brain damage and primary cerebral tumours.Contraindications to organ donation include age (>70 years), malignancy (except primary cerebral tumour), juvenile onset diabetes, intravenous drug abuse, severe multiorgan dysfunction, and systemic