Organ Harvesting Anesthesia

maxsquared · Oct 28, 2007

I would also like to hear more about this. Its one of those things one wouldnt normally think about. But, I guess necessary to sustain the organs? By the way, this seems like an appropriate topic for Halloween!!

nyapa, RN · Oct 29, 2007

I'd be interested to hear about this as well.

amiandjim · Oct 29, 2007

I find it interesting that anesthesia is required for the donor body, already pronounced clinically dead, during the harvesting of organs for donation. Yes, anesthesia is not just for the living. Does the CRNA role involve actively trying to keep all of the hemodynamic parameters stable to maintain the viability of the organs prior to surgical removal? If so, I would assume that this is very challenging. Are there any CRNA's out there in "CRNA land" that would be able to provide more insight into this very fascinating topic? Thanks in advance, I would be very interested in hearing about your experiences.

Yes, the role of the CRNA/anesthesia provider in organ donation is to keep the patient alive and to keep the organs healthy. Typically, the only anesthetic medication given to the patient is muscle relaxant to make it easier to make an abdominal incision/harvest the organs. The CRNA maintains the gtts the patient is on, as well as administers other medications to maintain hemodynamics. In the one organ harvest I have done as an anesthesia student, the patient coded as soon as incision was made. We began CPR, gave epi and then quickly gave heparin so the aorta could be cross-clamped. Once the aorta was clamped, we turned of the anesthesia machine and left the OR. It was a very strange feeling.

EmeraldNYL, BSN, RN · Oct 29, 2007

Yes, CRNAs do participate in anesthesia for organ donation. Obviously you don't need to give them any gas, but they usually come to the OR on a ton of drips to maintain proper hemodynamic parameters, and you must manage the BP, send lots of labs, etc. After they clamp the pulmonary artery you turn off the vent and leave the room.....

allnurses Guide · Oct 29, 2007

I find it interesting that anesthesia is required for the donor body, already pronounced clinically dead, during the harvesting of organs for donation. Yes, anesthesia is not just for the living. Does the CRNA role involve actively trying to keep all of the hemodynamic parameters stable to maintain the viability of the organs prior to surgical removal? If so, I would assume that this is very challenging. Are there any CRNA's out there in "CRNA land" that would be able to provide more insight into this very fascinating topic? Thanks in advance, I would be very interested in hearing about your experiences.

This is what I found in my Anesthesia Secrets book. Monitoring volume status, arterial, and CVP in addition to normal standards....The only "anesthetic" agent discussed is the use of a nondepolarizing muscle relaxants in order to block spinal reflexes that might cause movement in response to noxious stimuli. HTN/hypotension, tachycardia etc are treated as needed.

TJ8A · Nov 2, 2007

I'm a student and I've seen one. Mass Gen has a quaint overview for anesthesia's role. You'll have to dig for it though. We focused on hemodynamic stability, oxygenation, and fluid balance. I specifically remember that we had to keep reminding the procurement surgeon (for the heart/lungs) to stay off the vena cava because it was tanking the pt's pressure. We provided support even after the aortic cross-clamp to procure the lungs. Once the lungs were removed, we were done. We shut off the machine and left the room while they continued to harvest other organs (i.e. kidneys, bone, etc.) Kinda weird.

Qwiigley, BSN, MSN, DNP, RN, CRNA · Jan 15, 2008

I've done these. I usually run gas along with the required gtts, to prevent the hormonal pain response. The weirdest thing that I experienced, was on my first one, I was by myself and the surgeons were working on the heart, they wanted me to "drop the lungs". I thought about it for a split second and thought, I guess I just take them off the vent, they aren't gonna refill !?!! Then of course, when they take the last organ and you walk away. That is the strangest feeling.

The drugs you give, besides the gtts they are on, you have to give a lot of glucose and calcium. The harvest company usually gives us a list of what drugs, how much and when to give them. It is a rewarding experience. The coordinator will give you an idea of where the organs are going if you ask. You see just how many people can be saved with just one donor. I wish everyone would consent. (Did you know that if you consent, but anyone in your family objects, here in California, they won't harvest the organs?) BE SURE TO TELL YOUR FAMILY, you wan to donate. Talk about it often. They will then know your wishes for sure.

foraneman · Jan 17, 2008

We do about one per week at my institution. Each harvest is a bit different, depending on the hemodynamic stability of the donor and the organs being harvested. Often these patients are on dopamine, dobutamine, epinepherine, neosynepherine, nipride, nitro, beta blockers, or any other vasoactive/cardioactive gtt you can think of. Preservation of the kidneys and the heart require specific protocols for each. Since most are head injuries, increased intracranial pressure and specific affected brain tissue can cause a host of hemodynamic and physiologic difficulties. Many are trauma patients requiring continued resucitation with blood products.

Anesthetic agents are most oftened tailored to hemodynamic response desired to maitain organ perfusion. Muscle relaxants facilitate a relaxed surgical field for greater access. Often there are multiple surgical teams, one for each organ type. The heart :redpinkhe is stopped in a similar manner as in open heart surgery with bypass. Once the heart stops, anesthesia is done, the monitors and the machine are all turned off and the heart is harvested (snip, snip...pretty quick). The final harvest for bone tissue, corneas :bugeyes: and skin takes place after this.

armynse · Jan 17, 2008

You see just how many people can be saved with just one donor. I wish everyone would consent. (Did you know that if you consent, but anyone in your family objects, here in California, they won't harvest the organs?) BE SURE TO TELL YOUR FAMILY, you wan to donate. Talk about it often. They will then know your wishes for sure.

Ditto for Louisiana, surviving family members can override your wishes when it comes to organ donation. Having that little heart on your driver's license does not constitute consent to donate. As for CRNAs participating in organ recovery, I find this info fascinating. I guess I just thought that since the donor was clinically dead there was no need anesthesia support.

CaslaRN · Jan 18, 2008

Same in Georgia and Florida so please discuss with your family ...... in the end THEY not YOU have the final say.:redpinkhe

Nitecap · Jan 18, 2008

I find it interesting that anesthesia is required for the donor body, already pronounced clinically dead, during the harvesting of organs for donation. Yes, anesthesia is not just for the living. Does the CRNA role involve actively trying to keep all of the hemodynamic parameters stable to maintain the viability of the organs prior to surgical removal? If so, I would assume that this is very challenging. Are there any CRNA's out there in "CRNA land" that would be able to provide more insight into this very fascinating topic? Thanks in advance, I would be very interested in hearing about your experiences.

Plan: 100% O2, maintain ventilation O2 is vital to the organs. Keep pressure up to ensure organ perfusion. Give what ever drugs the donation people want you to, they are the experts in preserving organs. A little opioid can smooth things out. Even though the patient is dead they still have an sympathetic response to pain which can send HR and BP through the roof since the surgey is so traumatic. Heart out, turn off the vent whenever surgeon says its cool. Let them take the rest of the organs. Peace out.