Citerio Giuseppe, Cypel Marcelo, Dobb Geoff J, Dominguez-Gil Beatriz, Frontera Jennifer A, Greer David M, Manara Alex R, Shemie Sam D, Smith Martin, Valenza Franco, Wijdicks Eelco F M
School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
Neurointensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
Intensive Care Med. 2016 Mar;42(3):305-315. doi: 10.1007/s00134-015-4191-5. Epub 2016 Jan 11.
The shortage of organs for transplantation is an important medical and societal problem because transplantation is often the best therapeutic option for end-stage organ failure.
We review the potential deceased organ donation pathways in adult ICU practice, i.e. donation after brain death (DBD) and controlled donation after circulatory death (cDCD), which follows the planned withdrawal of life-sustaining treatments (WLST) and subsequent confirmation of death using cardiorespiratory criteria.
Strategies in the ICU to increase the number of organs available for transplantation are discussed. These include timely identification of the potential organ donor, optimization of the brain-dead donor by aggressive management of the physiological consequence of brain death, implementation of cDCD protocols, and the potential for ex vivo perfusion techniques.
Organ donation should be offered as a routine component of the end-of-life care plan of every patient dying in the ICU where appropriate, and intensivists are the key professional in this process.
由于器官移植往往是终末期器官衰竭的最佳治疗选择，器官移植供体短缺是一个重要的医学和社会问题。
我们回顾了成人重症监护病房（ICU）实践中潜在的尸体器官捐赠途径，即脑死亡后捐赠（DBD）和循环死亡后控制捐赠（cDCD），后者是在计划撤除维持生命治疗（WLST）并随后使用心肺标准确认死亡之后进行的。
讨论了ICU中增加可用于移植的器官数量的策略。这些策略包括及时识别潜在的器官供体、通过积极处理脑死亡的生理后果来优化脑死亡供体、实施cDCD方案以及体外灌注技术的潜力。
在适当的情况下，应将器官捐赠作为在ICU死亡的每位患者临终关怀计划的常规组成部分提供，而重症监护医生是这一过程中的关键专业人员。
