European Consensus on Expansion of Thoracic Donor Pool (ECTTA)
0 likes87 views
This document outlines tasks and responsible roles for developing consensus recommendations on maximizing the use of organs recovered from cadaver donors. It proposes that each participant suggest two choices for each task to identify two individuals responsible for each task. Each task description would be made available online for editing by all participants. The draft divides tasks into areas like donor assessment, management, monitoring, organ preservation techniques, allocation protocols, and considerations for pediatric transplantations. Responsible roles would include clinicians, anesthesiologists, surgeons, and procurement agencies.
European Consensus on Expansion of Thoracic Donor Pool (ECTTA)
- 9. Possible causes of so low extraction of heart donors: PERCEIVED INCREASE OF PGF RATES IN THE LAST DECADE (role of recipient profile) INCREASE OF THE HAZARD FOR PGF WITH THE INCREASE OF DONOR AGE IF LONG ISCHEMIC TIME ARE PROJECTED IF HIGH DOSAGE OF INOTROPES INADEQUATE AVAILABILITY OF DATA (ANGIOGRAPHY, FUNCTIONAL DATA ETC.) PERCEIVED CLINICAL STABILITY OF OUTPATIENT RECIPIENT PERCEIVED AVAILABILITY OF A SURGICAL BACKUP TO TRANSPLANT (MCS) NOT FOR ALL COMPLEX USE FOR BIVENTRICULAR FAILURE
- 17. Landscape and Landmarks Potential Thoracic Organ Donor Early Donor Management Hemodinamic assessment Effective Thoracic Organ Donor Scouting
- 19. Heart Donor Assessment How: RISK FACTORS ECG Ecocardiography Stress Echocardiography ECO TE Angiography Biomarkers Other (CT scan etc.) Multiparametric Scores When ? Who: Local staff Donor Agencies
- 20. Lung Donor Assessment How: RISK FACTORS Radiography Blood Gas Analysis CT Scan Broncoscopy Ecography Microbiology Other (CT scan etc.) Multiparametric Scores When ? Who: Local staff Donor Agencies
- 21. Dynamics changes of Thoracic organs during donation process SYSTEMIC METABOLIC FAILURE BRAIN DEATH OXYGEN DELIVERY OXYGEN CONSUMPTION LACTATE OXYGEN EXTRACTION
- 22. Donor Management How: Swan-Ganz Catheter Other hemodinamic monitoring devices Continuous TEE Bronchoscopy When: ? Role of Early Management Who: Local ICU staff Donor Agencies Scouting Programs
- 23. 1st TOP-Course >ThoracicTransplantation< Adjust volume status: target CVP = 6-10 mmHg Correct acidosis:target pH = 7.4 7.45 Correct hypoxemia: target p02 > 80 mmHg, sat >95% Correct anemia: target HCT > 30%; Hb > 10 g/dl Adjust inotropics to keep MAP > 60 mmHg (dopamine/dobutamin < 10 袖g/kg/min) Place PAC Adjust fluids, inotropes and pressors 15 min to minimize use of alpha agonists and meet targets: MAP > 60 mmHg PCWP 8-12 mmHg C.I. > 2.4 Dopamine or dobutamine < 10 袖g/kg/min CVP 4-12 mmHg SVR 800 1200 dune/sec/cm-5 T3: 4 袖g bolus + infusion 3 袖g/hour Vasopressin: 1 unit bolus + infusion at 0.5 4 units/hour methylprednisolone=: 15 mg/kg bolus Insulin: 1 unit/ hour minimum Rule out structural abnormalities Crystal City Consensus circulation 2001
- 24. Inflammatory damage Hyperdynamic storm Endothelial activation ICAM VCAM selectins Neurogenic hypotension Inflammatory cell infiltration Pro-inflammatory cytokines (IL-6, TNF-@, IL-8) TLR - complement Early graft dysfunction Late graft dysfunctin Kidney, Heart, Lung, (Liver) PERFUSION RELEASE FROM BRAIN
- 27. DonorAssessment At Harvesting Time Ischemic Time Age (in absence of coronaric lesions) Inotropic dosage Are risk factors related to the actual gold standard of myocardial preservation: Cold Static Cardioplegic Solutions.
- 30. Donor Preservation How: Cold Static Hypotermic Ex vivo perfusion Normotermic Ex vivo perfusion When: ? Physiopathology of Brain Death Who: Donor Agencies Transplant Centers
- 31. Methods Each of the partecipants to the Core Group should purpose 2 choices for every task so to identify 2 responsibles for every task. Every task should be online on the dropbox open to modifications by everyone (word revision mode) so the responsibles of the tasks can accept or not modification of each of the component of the consensus. Every task may be developed indipendently but bibliographic service may be updated from every partecipants at the best of his knowledge.
- 32. Draft of Tasks and Responsible Role Tasks: Donor Assessment Donor Management Manage Modifiable Risk factors Donor Monitoring Brain Death Pathophysiology and timing for harvesting Scouting Programs Organ Preservation (DBD/DCD) Donor Allocation Protocols Proposal of logistic models to increase the rate of thoracic Organs Specific Considerations about pediatric transplantations Who: Clinicians (cardiologist/pneumologists) Anesthesiologist Anesthesiologist/Surgeon Clinicians/Anesthesiologist Anesthesiologists Cardiologist/Anesthesiologist Surgeons/Anesthesiologist Procurement/Surgeons Procurement Agencies Surgeons