| Summary: | 碩士 === 中國醫藥大學 === 臨床醫學研究所碩士班 === 98 === Objective：
Transplantation has become the standard treatment option for patients with end-stage organ failure. The most challenge in transplantation is the shortage of organs. In deceased donor, organ procurement is made after pronouncement of brain death. However, hemodynamic instability that follows brain death often makes the donor loss, lowers organ yield and jeopardizes graft quality. Optimizing medical donor management may have considerable impact of transplantation. We instituted an intensivist in-charged donor management protocol and investigated its effect.
Materials and Methods:
Records of all brain dead donors in a 1,300-bed medical center over an 8-year period (2002 ~ 2009) were reviewed. In March 2006, a donor management protocol was instituted. All potential donors were transferred to the same intensivist. The protocol was constituted with functional hemodynamic monitoring by arterial pulse contour analysis technique, aggressive fluid resuscitation according to stroke volume variation, early use of vasopressin for diabetes insipidus and routine use of oral levothyroxin and parenteral hydrocortisone. Data regarding donor loss, organs transplanted per donor, inotropic agent use, shock or hypoxia episode at apnea test and immediate graft function after renal transplantation were compared before (January 2002 ~ February 2006,) and after (March 2006 ~ December 2009) the protocol.
Results：
There were 54 potential donors in the 8-year period. Of those, 22 were in the pre-protocol period; 2 lost due to hemodynamic instability, and one happened to cardiac arrest at apnea test. The other 32 were in the post-protocol period, all became actual donors. With comparison, the donors managed by the protocol had more organs transplanted per donor (3.21 ± 0.92 vs. 3.91 ± 0.64, p < 0.01), less preoperative dosage of inotropics : dopamine (9.33 ± 8.21 vs. 0.19 ± 0.64, p < 0.001), norepinephrine (3.00 ± 4.58 vs. 0.16 ± 063, p < 0.01), fewer shock episodes at apnea test (14/19 vs. 3/32, p < 0.001) and hypoxia （14/19 vs. 3/32, p < 0.001）, less slow graft function in renal recipients (13/30 vs. 6/39, p < 0.01) and more rapid decrease of serum creatinine level.
Conclusion：
This study shows that intensivist in-charged protocol guided donor management can reduce potential donor loss, increase organs transplanted per donor, and assure donor safety at apnea test and better graft quality.
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