Management of Potential Organ Donor: Indian Society of Critical Care Medicine-Position Statement

Abstract

This position statement is documented based on the input from all contributing coauthors from the Indian Society of Critical Care Medicine (ISCCM), following a comprehensive literature review and summary of current scientific evidence. Its objective is to provide the standard perspective for the management of potential organ/tissue donors after brain death (BD) in adults only, regardless of the availability of technology. This document should only be used for guidance only and is not a substitute for proper clinical decision making in particular circumstances of any case. Endorsement by the ISCCM does not imply that the statements given in the document are applicable in all or in a particular case; however, they may provide guidance for the users thus facilitating maximum organ availability from brain-dead patients. Thus, the care of potential brain-dead organ donors is "caring for multiple recipients."

How to cite this article: Zirpe K, Pandit R, Gurav S, Mani RK, Prabhakar H, Clerk A, et al. Management of Potential Organ Donor: Indian Society of Critical Care Medicine-Position Statement. Indian J Crit Care Med 2024;28(S2):S249-278.

Keywords: Ancillary tests; Apnea test; Brainstem death; Extended organ donation criteria; Hurdles for organ donation in India; Infusion and pumping; Pharmacological treatment approach in management of organ donation; Ventilation.

Fig. 1

Prerequisites for brainstem death diagnosis

Fig. 2

Structure of National Organ Transplantation Program NOTTO, National organ and tissue transplant organization; ROTTO, Regional organ and tissue transplant organization; SOTTO, State organ and tissue transplant organization

Figs 3A to D

Neurological examination and AT with PEEP valve AT, apnea Test; PEEP valve, positive end expiratory pressure valve

Fig. 4

A PEEP valve

Fig. 5

Troubleshooting in AT AT, apnea test; CO₂, carbon dioxide; COPD, chronic obstructive pulmonary disease; ECMO, extra corporeal membrane oxygenation; PEEP, positive end expiratory pressure; V-V ECMO, veno-venous ECMO

Fig. 6

Sequential steps for deceased organ donation DSP, deputy superintendent of police; SHO, station house officer; SOTTO; state organ and tissue transplant organization; ZTCC, zonal organ transplant coordination center

Fig. 7

Pathophysiological events in brainstem death and change in goals CBF, cerebral blood flow; CPP, cerebral perfusion pressure; ICP, intracranial pressure; SVR, systemic vascular resistance

Fig. 8

Multisystemic effect of brainstem death AMI, acute myocardial infarction; CaO₂, arterial oxygen content; CHF, congestive heart failure, DO₂, delivery of oxygen; HB, hemoglobin; HR, heart rate; PaO₂, partial pressure of oxygen, SaO₂, oxygen saturation; SV, stroke volume

Fig. 9

Main objectives of organ donor management

Fig. 10

Flow diagram of VIPP approach for hemodynamic management of brain-dead patient DI, diabetes insipidus; ECMO, extracorporeal membrane oxygenation; HRT, hormonal replacement therapy; LV, left ventricle; MAP, mean arterial pressure; PaO₂, partial pressure of oxygen; PaCO₂, partial pressure of carbon dioxide; SVV, stroke volume variation; PPV, pulse pressure variation; UOP, urine output