Department of Anesthesiology and Pain Medicine.
Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
Curr Opin Crit Care. 2020 Apr;26(2):155-161. doi: 10.1097/MCC.0000000000000705.
Increasing numbers of deaths on the transplant waiting list is associated with an expanding supply-demand deficit in transplantable organs. There is consequent interest in reviewing both donor eligibility after death from traumatic brain injury, and subsequent management, to minimize perimortem insult to donatable organs.
Recipient outcomes are not worsened when transplanting organs from donors who were declared dead after traumatic brain injury. Protocolized donor management improves overall organ procurement rates and subsequent organ function. Longer periods of active management (up to 48 h) are associated with improved outcomes in renal, lung, and heart transplantation. Several empirically derived interventions have been shown to be ineffective, but there are increasing numbers of structured trials being performed, offering the possibility of improving transplant numbers and recipient outcomes.
New studies have questioned previous considerations of donor eligibility, demonstrating the ability to use donated organs from a wider pool of possible donors, with less exclusion for associated injury or comorbid conditions. There are identifiable benefits from improved donor resuscitation and bundled treatment approaches, provoking systematic assessments of effect and new clinical trials in previously overlooked areas of clinical intervention.
移植等待名单上死亡人数的增加与可移植器官的供需缺口扩大有关。因此，人们对创伤性脑损伤后死亡的供体资格以及随后的管理进行了审查，以尽量减少供体器官的濒死期损伤。
将来自创伤性脑损伤后被宣布死亡的供体的器官移植到受者体内并不会使受者的预后恶化。方案化的供体管理提高了整体器官获取率和随后的器官功能。更长时间的主动管理（长达 48 小时）与改善肾、肺和心脏移植的预后相关。一些经验性衍生的干预措施已被证明无效，但越来越多的结构化试验正在进行，这为提高移植数量和受者预后提供了可能。
新的研究质疑了先前对供体资格的考虑，证明了能够从更广泛的潜在供体池中使用捐献的器官，对相关损伤或合并症的排除更少。通过改善供体复苏和综合治疗方法，可以获得明确的益处，这促使人们对以前被忽视的临床干预领域进行系统评估并开展新的临床试验。
