Transplantation proceedings
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We present the case of a 46-year-old woman referred to our center for urgent heart transplantation assessment, initially diagnosed as having cardiogenic shock of uncertain etiology. Some hours before she had suffered syncope without regaining consciousness. When she arrived at our hospital, the objective examination revealed bilateral unreactive mydriasis and absent brain-stem reflexes, and echocardiography showed global left ventricle wall hypokinesis sparing the apex. ⋯ For this reason it should not constitute an absolute contraindication to cardiac donation in young donors with no previous cardiac disease. In our hospital during the last year one third of the potential heart donors had regional left ventricle wall motion abnormalities compatible with neurogenic stunned myocardium. With the aim of improving the number of cardiac donors, several strategies have been described to try to demonstrate the reversibility of this entity, such as dobutamine stress echocardiography.
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Impact of catastrophic brain injury guidelines on donor management goals at a level I trauma center.
An organ procurement organization (OPO) and a level I trauma center developed catastrophic brain injury guidelines (CBIGs) to assist in the care of severely brain-injured adult patients before brain death. The CBIGs provided a set of clinical guidelines to maintain patient stability and optimize opportunity for organ donation. ⋯ While other factors may have contributed to our results, we think that there is a positive relationship between the CBIGs and the increase in meeting most DMGs. As we refine our donor management, we will focus on the factors we met less successfully. Ultimately, the use of the CBIGs before brain death led to more stable donors, maximizing transplantable organs.