[Resuscitation of children with brain death in view of organ procurement for therapeutic use]

Abstract

Among the different stages from donor to recipient, the intensive care of children in a state of brain death (BD) is of paramount importance, the first step being having this goal in mind. As soon as procurement is contemplated and medico-legal formalities have been completed, all potentially involved persons and institutions (France-transplant, procurement and transplantation teams, immunology laboratory, recipients) must be contacted. Intensive care, started at the stage of irreversible coma, will be pursued near the place where procurement will be performed, geared to the obtention of multiple organs. Transportation is often required (for arteriography or procurement), but is carries a risk since BD creates an unstable situation which at any moment may turn into cardiac arrest. Under such conditions, intensive care has two main objectives: 1) to ensure adequate haemodynamics and tissue oxygen supplies, and 2) to avoid infection. After a 10 to 20 hours period of intensive care and after procurement a detailed report on both surgery and intensive care must be laid down.