Organ Harvesting Anesthesia

[naturalgas]

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.

[NRSKarenRN, BSN, RN]

Thanks for this great read...learned something new today.

[Spoiled1, MSN, RN]

Several posts mentioned weird feelings. Why do you say that? What gives you the weird feelings? Is it leaving the room with no patient? Sorry if this is dumb, but I find it fascinating too....

[stanman1968]

The weird felling is just turning off the vent and walking away, sans patient.

[organdonornurse]

First off - the word "harvest" is no longer correct in referring to organ donation. The words "recovery" or "procurement" should be used. Organ donor families have stated they do not want to refer to their loved one's organs as harvested.

Secondly, the role of anesthesia in the OR during a recovery is to provide hemodynamic support to keep the organs perfused until the aorta is cross clamped. We do ask that a muscle relaxant be given while opening the chest to prevent any muscle spasm. In most donations, the donor's heart is beating but they are not alive. There are two definitions of death - brain death which is the complete and irreversible functions of all aspects of the brain including the brain stem (Harvard Criteria, 1968). The second definition of death is cardiac death. There is no sympathetic pain response because the brain is dead. Some donors do have spinal reflexes which do not involve the brain. After the aorta is cross clamped there is obviously no need for anesthesia as hemodynamic support is not necessary.

I would be more than happy to answer any questions, as I have been doing organ donor management and recoveries for the past two years.

[Qwiigley, BSN, MSN, DNP, RN, CRNA]

Dear Organdonor nurse;

It sounds like you were annoyed with this thread.. Sorry. This is an anesthesia thread and it is written from our point of view.

When you work your entire career to keep a patient alive it will always be weird and strange to "just walk away" from a room and leave your pt there. We never leave a patient alone. EVER. (Without an ANESTHESIA person). We don't step out for just a minute. Never leave a patient with a nurse or the surgeon.

This thread is discovery and venting. Not always for "sensitive" ears.

That said, thank you for the offer to answer questions. Wow, 2 years, looks like you are beginning to explore a nice career. I wish you the best of luck and compassion, that job is something to be proud of, as you polish your halo daily.

[organdonornurse]

I didn't mean to come across as annoyed. There are so many misconceptions and since people don't see it every day they don't have a full understanding of the process. We always appreciate CRNAs in the OR - you are an essential part of what we do. I was doing some research and came across this thread and I felt it was important to clarify some of the statements made. One way to look at the process is to think that although we can't save the donor, we are actually taking care of the recipients. You all help save many lives when doing organ recoveries.

[mt33133]

I know this is an older post, however I have been deeply disturbed by an organ procurement I observed as a student nurse. I was able to speak with the anesthesiologist regarding what type of anesthesia he was using. He said none. I then asked the nurse who was the organ procurement coordinator about why no anesthesia was being used and I was told because the anesthesia would damage the organs. The patient had been declared "brain dead" and apparently because of this determination everyone felt like no anesthesia was needed. However, I am concerned because of all the reports that have come out regarding lack of consistency by hospitals in using brain death criteria established by the American Academy of Neurology. Every hospital has its own policies and procedures. The truth is that we don't know what a patient is experiencing who is lying on an OR table during organ procurement. I guess my question is this, does anesthesia really harm the organs? What is the harm in providing anesthesia during the surgery?

I took an informal poll of other nursing students regarding organ donation and no other nursing student knew organ procurement without anesthesia was common practice and I am pretty sure loved ones of those donating their organs have no idea this is taking place either.

This experience just really bothered me and I am seriously reconsidering becoming an organ donor, or at least state in an advance directive, etc. that organ donation can only take place if certain anesthetics are used.

[RRTNeuroRN]

The reason no anesthesia is used is because the patient is DEAD. And yes, antesthesia CAN damage organs. Most of these patients are already treading a fine line with blood pressure because the brain dead patient is usually extremely unstable. Most of them are maxed out on levophed or other pressors and the addition of any anesthetic could decrease their pressure even further and that could damage their organs.

Nursing students probably don't know that much about donation and anesthesia anyway so I am not surpirised that students wouldn't know the procedure for organ procurement.

Organ donation is the most wonderful gift a family in pain could ever give to someone else. These family members must understand prior to agreement that their family member is dead and that even though the heart is beating and they are warm, they are still dead. The organ donation center in Georgia is Lifelink and they are wonderful. They speak with the family and make sure that they are fully aware of everything that has and will take place.

Organ donation is a very personal decision and if you are not comfortable with yours then by all means find out whatever you need to in order to make a more informed decision.

I am an organ donor and I fully understand the procedure for brain death criteria and procurement and I am comfortable with it. To each their own.

[cessnadriver]

Hmmm Nice thread... now for some fireworks.... any CRNAs on the forum ever get involved in NON-BRAIN DEAD organ donation? And I am not talking about living donor organ removals. This may take a while to post as it has to be moderated so the flow of discussion may not be smooth.

[CRNA1906]

Thanks for the great read RRTNeuroRN. Maybe we can communicate via PM soon?

[foraneman]

Just to clarify a bit: Anesthesia is NOT withheld during organ procurement procedures due to a consideration that the patient is 'dead'. Nor do any anesthetics damage the organs pharmacologically. The goal of anesthesia care during these procedures is to maintain oxygenation and perfusion of the organs in question. Administration of anesthetic agents is tailored to this goal. So, as long as hemodynamics allow, common practice is to administer an anesthetic, though anesthesia requirements are much lower to blunt surgical response in brain dead individuals.

As for the post about non-brain dead organ donors.....and why you ask that I have no idea....the procedure you refer to there is homocide, so no.

[MP5PDW]

Non brain dead organ donors are those who do NOT meet brain death criteria, BUT are going to be "terminally weaned" from the vent. In other words support will be withdrawn. The patient is taken to the OR, the wean is done and once the heart stops, the organs are harvested. Yes it is being done and is quite controversial to say the least.