Anesthetic Considerations of Organ Procurement After Brain and Cardiac Death: A Narrative Review

Organ donation procedures have become more frequent in the US as the need for transplants is increasing. Defining the anesthesiologist's role in organ donations after brain and cardiac death is important, as is understanding its ethics and practical physiologic and perioperative implications. Despite this, there are few papers specifically addressing the anesthetic management of organ donors. This review summarizes the preoperative, intraoperative, and postmortem considerations for the anesthesiologist involved in organ donation after either brain or cardiac death. A search of the published literature was performed using PubMed, Excerpta Medica dataBASE (EMBASE), and Google Scholar in March of 2022 for articles addressing anesthetic considerations of organ procurement surgeries after brain and cardiac death. This review demonstrates that anesthesiologists play a significant role in the organ procurement process. Their role in the perioperative management of the donor may affect the outcomes of organ transplantation. The gap between the number of organs harvested and the number of patients awaiting organ transplantation remains high despite continued efforts to increase the number of available organs. Perioperative management of organ donors aims at counteracting the associated unique physiologic derangements and targets optimization of oxygenation of the organs intended for procurement. Optimizing care after death can help ensure the viability of organs and the best outcomes for recipients. As organ donation after cardiac death (DCD) becomes more frequent in the US, anesthesiologists should be aware of the DCD classifications of donors and emerging novel perfusion techniques.

Awareness Level Regarding Brain Death and the Acceptance of Organ Donation in Eastern Province, Saudi Arabia

Background There is a worldwide shortage of organ donations. In the United States, 20% of people on transplant waiting lists pass away annually due to the lack of accessible organs. Patients with brain death can donate organs, which may save other patients' lives. The Saudi Ministry of Health endorses brain death as equivocal to whole-body death. A study conducted in Saudi Arabia showed that there was a mild to moderate level of awareness regarding brain death. This study aimed to investigate the awareness and knowledge level regarding brain death and the acceptance of organ donation among the general population in Eastern Province, Saudi Arabia. Methodology An observational, cross-sectional study was conducted among 1,740 adults using an online questionnaire created and published in February 2023 to collect data from Saudi males and females aged 18 or older who were willing to participate in the study. The data were analyzed using SPSS version 23.0 (IBM Corp., Armonk, NY, USA) after collecting and entering them using the Windows version of Microsoft Office Excel 2016. Results Overall, 85.6% of the study participants had heard about organ donation. Of them, about 42.4% were aware of brain death. Further, 40% of participants were in agreement with organ donation. According to the findings, the majority of participants (60.9%) believed that a person could donate his or her organs during their life, while only 42.6% were unaware that they could donate their organs during death. Only 10.8% of participants knew that blood can be donated. There was no significant association between factors associated with organ donation and gender, education level, or monthly income. Conclusions This study concluded that study participants had a low level of awareness about brain death. Understanding brain death is essential for persuading people to donate their organs. Thus, more has to be done to inform and educate people about brain death and how it affects organ donation.

Characteristics of Organ Donors Who Died From Suicide by Hanging in Australia and New Zealand: A Retrospective Study

Background and objective The annual incidence of suicide by hanging in Australia and New Zealand has increased in the past decade, and a significant number of these individuals are becoming organ donors. The rates of organ donation following deaths from hanging is unknown and the characteristics of this cohort of donors have not been described in the literature. In light of this, we aimed to examine the trends in organ donation from individuals who had died from hanging, based on the solid organ donor data from the Australia and New Zealand Organ Donation (ANZOD) Registry. Methods We conducted a retrospective study that analyzed the ANZOD Registry donor data (2006-2015) to describe the characteristics of solid organ donors who had died by hanging (post-hanging group); these characteristics were compared to those of individuals who died by all other causes (non-hanging group). Results During the study period, the number and proportion of donors who died by suicide from hanging increased. Of the 4,024 consented organ donors, 226 had died by hanging and 3,798 had died from other causes. The probability that an individual who died by hanging would become an organ donor increased from 0.5 to 3%. Compared to donors who died by all other causes, post-hanging donors were younger (median age of 30 vs. 50 years), with fewer comorbidities, and a higher incidence of smoking. There was no significant difference in the proportion of those who indicated a prior intent to donate organs between post-hanging (34%) and non-hanging donors (38%). A higher proportion of post-hanging donors donated via the donation after the circulatory death pathway (36.3%) than non-hanging donors (24.2%). Individuals in the post-hanging cohort donated an average of 4.19 organs compared to 3.62 in the non-hanging cohort. Conclusion We believe the findings of this retrospective analysis will help inform clinical decision-making regarding organ donation, including the best approaches to obtaining donation consent. Our findings will help physicians provide care to patients and to families of individuals in this challenging group, where organ donation potential is high. Further investigations are required to determine which aspects of healthcare influence the donation rates in individuals who have died by hanging and the outcomes related to transplanted organs.