Continuing Education in Anaesthesia Critical Care and Pain | Volume 4 Number 3 | 2004
Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 3 2004 © The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Management of the potential heart-beating organ donor
Newcastle General Hospital, Westgate Road, Newcastle, NE4 6BE
Newcastle General Hospital, Westgate Road, Newcastle, NE4 6BE
The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW
Tel: 01642 854600, Fax: 01642 854335, E-mail: steve.bonner{at}btinternet.com (for correspondence)
Although St Cosmas and St Damian are said to have miraculously performed a leg transplant in the third century, the first documented organ transplant took place in France in 1906, when Jaboulay grafted a pig kidney into the antecubital fossa of a woman dying of renal failure. Voronoy in Russia performed the first human to human kidney transplant in 1933 using a donor kidney from a woman who had died 6 h before. Unsurprisingly, all of these procedures failed. It was only in the 1940 s that the role of the immune system in rejection of transplanted organs was recognized and over the next two decades work began on the immunosuppressive therapy which would make transplantation possible.
The advent of artificial ventilation and Intensive Care in the 1950 s resulted in the first brainstem-dead heart-beating patients. Diagnostic criteria for brainstem death were subsequently developed and, in 1968, after a complex ethical and philosophical debate, brainstem death was accepted as being equivalent to somatic death by the World Medical Association. This was accepted in 1976 in a memorandum from the Conference of the Medical Royal Colleges and their Faculties which allowed discontinuation of ventilation of such patients in the UK.
The development of the concept of brainstem death also made organ transplantation from heart-beating donors possible. This review summarizes the management of potential heart-beating organ donors.