• Heart beating organ donation
    Link:www.anaesthesia.ie/archive/ICSI/ICSI%20Guidelines%20MAY10.pdf
    • Donor criteria
      • Under 75
      • Not HIV +ve
      • Not Hep B/C +ve
      • No untreated sepsis/malignancy
      • Not fixed as can transplant HIV organ into HIV recipient
    • Physiological changes with BSD
      • Hypotension (80%)
      • DI (65%)
      • DIC (30%)
      • Arrhythmias (30%)
      • Pulmonary oedema (20%)
      • Metabolic acidosis (10%)
    • Catecholamine surge
      • Tachycardia, hypertension, high co, high SVR, arrhythmias all occur during brainstem ischaemia
      • Later, sympathetic activity is lost
    • Lungs
      • NPO is common, may have pneumonia, aspiration, atelectasis
    • Endocrine
      • DI, low T3, low TSH, low insulin secretion
    • Temperature
      • Hypothermia is common
    • Haematology
      • Coagulopathy is common
    • Immune
      • Increased immunosensitivity of organs causes higher rates of rejection
    • Management
      • Optimal management should continue and focus on the organs considered suitable for transplantation
      • Lungs
        • Lungs for transplant should be able to achieve a pO₂ of 50kPa with FiO₂ of 1.0 and PEEP of 5
        • Continue physio, lavage and sputum MC&S
        • Vt of 6-8ml/kg
        • Keep FiO₂ as low as possible to keep PaO₂ of >10kPa
        • PEEP of 5-10
      • Circulation
        • Fluids
        • CI 2.2-2.5L/min/m²
        • MAP > 70
        • Use vasopressin 1st, dopamine 2nd, NA 3rd
      • Endocrine
        • DDAVP, T3, insulin may be needed
      • Temp control
        • Air warmer and FW should be used
      • Haematology
        • Treat coagulopathy
        • Cross match 4u for procurement
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/4/3/86.full.pdf
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/early/2012/05/23/bjaceaccp.mks026.full.pdf