Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery: A United Kingdom and Canadian proposal.
Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery: A United Kingdom and Canadian proposal.
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DOI：
10.1111/ajt.15775
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发表时间：
2020-08
期刊：
影响因子：
--
通讯作者：
Watson CJE
中科院分区：
文献类型：
--
作者：
Manara A;Shemie SD;Large S;Healey A;Baker A;Badiwala M;Berman M;Butler AJ;Chaudhury P;Dark J;Forsythe J;Freed DH;Gardiner D;Harvey D;Hornby L;MacLean J;Messer S;Oniscu GC;Simpson C;Teitelbaum J;Torrance S;Wilson LC;Watson CJE
在确定死亡方面存在国际差异。循环死亡（DCD）后的捐赠死亡可以定义为脑循环的永久停止。应禁止恢复脑灌注的死后干预，因为它们使死亡诊断无效。回收团队应制定方案，确保在DCD器官回收期间持续缺乏脑灌注。在原位常温区域灌注（NRP）或重新启动心脏在供体的身体可能会中断永久停止脑灌注，因为，从理论上讲，侧支循环可能会恢复it.We提出改进目前的协议，以监测和排除脑再灌注在原位NRP。在腹部NRP中，在大多数情况下，降主动脉的完全闭塞阻止了脑灌注。在升主动脉中插入插管可以识别降主动脉或任何侧支血流的不充分闭塞，并将血流从大脑转移。在胸腹NRP中，将主动脉弓血管开放到大气中允许侧支血流从脑中转移，维持死亡的永久标准并尊重死亡供体规则。我们认为，这些假设是正确的，当使用的技术，同时闭塞降主动脉和开放主动脉弓血管大气。作者介绍了通过确保任何可能的侧支供应转移来防止原位常温区域灌注期间脑灌注恢复的技术。
There is international variability in the determination of death. Death in donation after circulatory death (DCD) can be defined by the permanent cessation of brain circulation. Post‐mortem interventions that restore brain perfusion should be prohibited as they invalidate the diagnosis of death. Retrieval teams should develop protocols that ensure the continued absence of brain perfusion during DCD organ recovery. In situ normothermic regional perfusion (NRP) or restarting the heart in the donor's body may interrupt the permanent cessation of brain perfusion because, theoretically, collateral circulations may restore it. We propose refinements to current protocols to monitor and exclude brain reperfusion during in situ NRP. In abdominal NRP, complete occlusion of the descending aorta prevents brain perfusion in most cases. Inserting a cannula in the ascending aorta identifies inadequate occlusion of the descending aorta or any collateral flow and diverts flow away from the brain. In thoracoabdominal NRP opening the aortic arch vessels to atmosphere allows collateral flow to be diverted away from the brain, maintaining the permanence standard for death and respecting the dead donor rule. We propose that these hypotheses are correct when using techniques that simultaneously occlude the descending aorta and open the aortic arch vessels to atmosphere. The authors present techniques to prevent the restoration of brain perfusion during in situ normothermic regional perfusion by ensuring the diversion of any possible collateral supply.
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