2 thoughts on “Episode 251: Organ Donation with Drs. Vail and Goyal”
Thank you for this important discussion.
I’ve worked with colleagues who even in the setting of a patient with brain death, elect to administer some amount of volatile anesthesia and/or IV anesthesia/analgesia during organ procurement. I do believe they have an appropriate understanding of the physiology here, but choose to administer these agents in the interest of compassionate care in conjunction with his or her beliefs surrounding death, spirituality, etc.
Are there any data looking at outcomes regarding on this practice. If it contributes to worser outcomes, do you have any recommendations on how to counsel or work through this understandably sensitive and emotional topic?
Great question Stephen. Here is a response from Dr. Vail:
That’s a really good question that speaks to the personal difficulties that we can have with these cases, which are completely different from anything else that we encounter. Even when someone understands, academically, that there is no blood flow to the brain after brain death and therefore no delivery of anesthetics, I understand that we commonly use these medications for comfort in living patients and want to do the same for donors.
I can offer two references, both observational studies:
Administration of anesthetics and hypnotics is not uncommon in a single US hospital (Lele et al.)
Administration of volatile anesthetics, which has the theoretical benefit of reducing ischemia reperfusion injury, is not associated with improved graft survival outcomes but is associated with slightly more intraoperative hypotension (Perez-Protto et al.,)
However, neither study speaks to why an individual donor received these medications (was it similar to your colleague, or specifically for management of intraop hypertension).
In my view, compassionate care is evidence-based care, or as George Eliot said, knowledge is the highest form of empathy. Delivering evidence-based care that aims to support the most number of organs for transplantation is another way to offer compassion that may emanate outward from these tragedies in service of many other patients.
Thank you for this important discussion.
I’ve worked with colleagues who even in the setting of a patient with brain death, elect to administer some amount of volatile anesthesia and/or IV anesthesia/analgesia during organ procurement. I do believe they have an appropriate understanding of the physiology here, but choose to administer these agents in the interest of compassionate care in conjunction with his or her beliefs surrounding death, spirituality, etc.
Are there any data looking at outcomes regarding on this practice. If it contributes to worser outcomes, do you have any recommendations on how to counsel or work through this understandably sensitive and emotional topic?
Great question Stephen. Here is a response from Dr. Vail:
That’s a really good question that speaks to the personal difficulties that we can have with these cases, which are completely different from anything else that we encounter. Even when someone understands, academically, that there is no blood flow to the brain after brain death and therefore no delivery of anesthetics, I understand that we commonly use these medications for comfort in living patients and want to do the same for donors.
I can offer two references, both observational studies:
Administration of anesthetics and hypnotics is not uncommon in a single US hospital (Lele et al.)
Administration of volatile anesthetics, which has the theoretical benefit of reducing ischemia reperfusion injury, is not associated with improved graft survival outcomes but is associated with slightly more intraoperative hypotension (Perez-Protto et al.,)
However, neither study speaks to why an individual donor received these medications (was it similar to your colleague, or specifically for management of intraop hypertension).
In my view, compassionate care is evidence-based care, or as George Eliot said, knowledge is the highest form of empathy. Delivering evidence-based care that aims to support the most number of organs for transplantation is another way to offer compassion that may emanate outward from these tragedies in service of many other patients.