Article type
Abstract
Background: Organ shortage for transplantation has become an important public health problem. Better management of potential donor may increase effective organ donation, number of organs recovered, and quality of organs transplanted.
Objectives: To present the recommendations of the Brazilian guideline for the management of potential brain-dead donors.
Methods: The guideline was developed through the collaborative efforts of the Brazilian Society of Intensive Care (AMIB), the Brazilian Organ Transplantation Society (ABTO), the Brazilian Research in Intensive Care Network (BRICNet), and the Brazilian Ministry of Health. Questions were drafted in July 2016; guideline scope was based on AMIB-ABTO guidelines for maintenance of adult patients with brain death and potential for multiple organ donations, published in 2011. Important outcomes considered for decision making were: cardiac arrest, number of organs recovered or transplanted, and clinical outcomes in the organ recipient (e.g. delayed graft function, need for hemodialysis, and organ survival). We conducted rapid systematic reviews for evidence search and synthesis; quality of evidence was assessed using GRADE. Guideline meetings occurred in November 2016 and February 2017; guideline panel was composed of intensivists, transplant co-ordinators, professionals from various transplant teams, and Brazilian Ministry of Health representatives. GRADE evidence to decision tables were used for making recommendations.
Results: We provided 21 clinical practice recommendations regarding temperature control, mechanical ventilation, vital signs, electrolyte control, blood pressure management, hormone replacement, diet, use of antibiotics, blood transfusion, and use of checklists. Most recommendations were considered conditional (weak) and quality of evidence was low or very low.
Conclusions: The use of evidence-based guidelines may improve the management of potential brain-dead organ donors. Although this guideline has been developed for the Brazilian context, it may be adopted by or adapted to other countries.
Objectives: To present the recommendations of the Brazilian guideline for the management of potential brain-dead donors.
Methods: The guideline was developed through the collaborative efforts of the Brazilian Society of Intensive Care (AMIB), the Brazilian Organ Transplantation Society (ABTO), the Brazilian Research in Intensive Care Network (BRICNet), and the Brazilian Ministry of Health. Questions were drafted in July 2016; guideline scope was based on AMIB-ABTO guidelines for maintenance of adult patients with brain death and potential for multiple organ donations, published in 2011. Important outcomes considered for decision making were: cardiac arrest, number of organs recovered or transplanted, and clinical outcomes in the organ recipient (e.g. delayed graft function, need for hemodialysis, and organ survival). We conducted rapid systematic reviews for evidence search and synthesis; quality of evidence was assessed using GRADE. Guideline meetings occurred in November 2016 and February 2017; guideline panel was composed of intensivists, transplant co-ordinators, professionals from various transplant teams, and Brazilian Ministry of Health representatives. GRADE evidence to decision tables were used for making recommendations.
Results: We provided 21 clinical practice recommendations regarding temperature control, mechanical ventilation, vital signs, electrolyte control, blood pressure management, hormone replacement, diet, use of antibiotics, blood transfusion, and use of checklists. Most recommendations were considered conditional (weak) and quality of evidence was low or very low.
Conclusions: The use of evidence-based guidelines may improve the management of potential brain-dead organ donors. Although this guideline has been developed for the Brazilian context, it may be adopted by or adapted to other countries.