INTENSIVE-CARE MANAGEMENT OF PEDIATRIC ORGAN DONORS AND ITS EFFECT ONPOSTTRANSPLANT ORGAN FUNCTION

Objectives. 1. To document the clinical course of paediatric beating h eart organ donors, 2, To evaluate the effect of the ICU management of pediatric donors on the immediate function of transplanted organs, 3, To examine the validity of current donor selection criteria. Design. R etrospective chart review and case series study. Setting. Multidiscipl inary ICU of tertiary referral paediatric hospital. Patients. All pati ents who became solid organ donors between January 1980 and July 1990. Outcome Measures. 1, Incidence of major physiological abnormalities o f the cardiovascular, pulmonary, renal and metabolic systems. 2, Numbe r of organs retrieved and transplanted, reasons for non-translantation of donated organs, 3. Immediate post-transplant function of transplan ted organs. Results. Seventy-seven organ donors were identified from w hom 134 kidneys, 31 livers and 12 hearts were transplanted, Sixty (78% ) patients developed diabetes insipidus, Sustained hypotension occurre d in 41 (53.2%) and was commoner in patients treated with inotropic ag ents in the presence of a low central venous pressure and in patients with diabetes insipidus who did not receive anti-diuretic hormone repl acement. Twenty-seven patients suffered at least one cardiac arrest. T he data on post-transplant function were obtained for 129 kidneys (fro m 70 donors) 30 livers and 9 hearts, Fifty-two kidneys, 10 livers and 2 hearts were transplanted from donors who had suffered at least one c ardiac arrest without apparent adverse effect on post-transplant organ function, Thirty-six kidneys from 31 donors suffered either acute tub ular necrosis (ATN) or primary non-function, The donors of these organ s spent longer in ICU (60.6 +/- 45.7 versus 41.8 +/- 30.1 h p = 0.045) and had a higher mean maximum serum sodium concentration (163.4 +/- 1 0.9 versus 158.5 +/- 9.5 mmol/l p = 0.05) than those without these com plications. The serum creatinine concentration and degree of inotropic support did not predict post-transplant function. Standard biochemica l tests for hepatic function, the dose of inotropic agent received, ti me in ICU and incidence of hypotension did not predict post-transplant liver function.Conclusions. Aggressive fluid resuscitation and manage ment of diabetes insipidus may promote stability in paediatric organ d onors, Donor cardiac arrest does not alter the ICU course or compromis e post-transplant organ function, The current criteria used for donor selection failed to predict posttransplant organ function and their us e may increase organ wastage.