organ donation

Specialties CRNA

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I asked this question to my sister-in-law who is a SRNA but I just wanted to get the opinions of some CRNAs. I recently observed an organ procurement in my OR rotation. I was a little shocked by the fact that the donor did not receive any anesthesia what-so-ever. I know that she was brain dead, and that was the reason for not giving any anesthesia but I thought to myself, " how does anyone know that this woman can't feel this?" My sis-in-law stated that there are ways to tell if a person is able to "feel" or know they are experiencing pain. I was wondering if someone could explain this to me a little bit. She said that the person's BP and HR would skyrocket but I was thinking that if they are brain dead, maybe those funtions wouldn't work right. My husband and I are organ donors and nothing would change that, but we have children who, until I saw that surgery, we had decided to donate their organs if something ever happened to them. Now we're not so sure. Can anyone help me understand this a little better?:banghead:

Cool...I like to hear about that! That is something I haven't heard of...at least not in this country.
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Actually it was invented in this country:

http://www.medscape.com/viewarticle/563803_2

David Carpenter, PA-C

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Specializes in Anesthesia.
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Actually it was invented in this country:

http://www.medscape.com/viewarticle/563803_2

David Carpenter, PA-C

Thanks David that was very interesting. Organ donation seems to be your area of expertise. How common is organ procurement w/o pronouncing brain death/"NHBOD"? It is something I haven't seen or participated in.

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Thanks David that was very interesting. Organ donation seems to be your area of expertise. How common is organ procurement w/o pronouncing brain death/"NHBOD"? It is something I haven't seen or participated in.

Our program doesn't do NHBOD. We are in an area with relatively low MELD to transplant so it doesn't make as much sense. It seems to be more common in high MELD areas such as the Northeast or California.

David Carpenter, PA-C

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Specializes in MICU mainly, Now on to anesthesia school.

Donation after cardiac death (DCD) is becoming more and more common. There is a huge nation wide push for expansion of this program. Joint Commission is maneuvering to require all accredited hospitals to have a policy regarding DCD. They don't go so far as to require participation, but do state you must have a contingency plan. With the demand for organs ever increasing, popularity will also rise once the social 'taboo' wears off.

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Specializes in Neuro ICU.

We have done a few DCD's at my hospital. It is a much different feeling sending one of these pt's off to OR as opposed to one that has been pronounced....but it is still wonderful knowing this person could save many lives!!

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Not a CRNA but as someone who does the other end of things on a regular basis I can give you some answers.

I have a hard time believing the patient was given no anesthesia. Usually anesthesia uses some opiods or propofol as there can still be sympathetic pain responses even in patients without higher brain function. A paralytic is pretty much obligatory in any abdominal surgery to be able to get exposure. They may not be getting inhaled agents but the patients are still getting anesthesia.

The role of anesthesia is critical in organ procurement (harvest is generally not used anymore). The patients are often wildly unstable and the ability of anesthesia to maintain blood pressure and perfuse the organs is key. Usually once we cross clamp they shut everything down and leave.

There is a pretty good thread here:

https://allnurses.com/forums/f16/organ-harvesting-anesthesia-258257.html

The post on the second page by nitecap describes things pretty well.

To Pagerespiratory: There are three types of organ procurement done in the US. The deceased donor protocol is used most often. In this case the donor has been declared brain dead by protocol and is brought to the OR for procurement.

The second is DCD or donation after cardiac death (also called non-heart beating donation). In this case a donor who continues to have some brain function but has sustained a non-survivable event and whose continued care is futile then consideration is given if it is in the patients best interests to withdraw care. Only after this has been determined (in the absence of discussion of organ donation) can the family be approached about donation. If the family agrees the patient is taken to the OR and supportive measures are withdrawn. Comfort measures are still in place. The procurement team can have no direction over withdrawing measures (its a little more complicated than this but thats the basics). If the patient arrests within a set time period then the patient is rapidly cooled and perfused with preservative fluid. The team then procures the organs. If the patient does not arrest during the set time period they are usually taken back to the ICU and given comfort measures.

The third type is living donation and anesthesia is usually there for the whole case or it gets kind of messy:cool:.

To the OP: The protocols are set up to ensure that the donor does not suffer. Last year there were 21,000 families that made a difficult decision to donate. However there are still 98,000 patients on the waiting list.

David Carpenter, PA-C

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Thanks david, in retrospect I observed long bone harvests.

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