A 58-year-old man with a large intraparenchymal hematoma in the basal ganglia opened to ventricles with midline shift, anisocoria, reactive pupils, mild left corneal reflex and right.
The intervention was ruled out by the neurosurgeon due to the location and extent of the bleeding.
After informing the family about the poor prognosis, the family voluntarily proposed the donation.
As in the previous case, he was asked to wait for death, which he accepted.
On the seventh day the neurological examination was similar and the family expressed their desire not to continue with life support measures, accepting donation after LT.
The patient remained in the operating room, asystole took place at 14 minutes, as in the previous case.
The ICT was 21 minutes.
For the same reasons as in the first case only both kidneys were explanted.
It has been commented that donation after death (DME) can be negatively affected when DCD is encouraged.
In the two cases presented, death did not occur despite a wait of 5 and 7 days, respectively.
If there was no controlled asystole donation program, both donors would have been lost after the family request not to continue with life support.
Most protocols favor cold perfusion through femoral catheters placed premortem, reducing ICT and hepatic donation requiring shorter ICT.
However, rapid laparotomy may be a reasonable option, especially in kidney and lung donation.
In both cases, the ICT were short, 23 and 21min respectively and within the time allowed for kidney donation.
A higher incidence of delayed renal graft function with kidneys from CMD has been described, although no differences have been found in the long-term evolution.
The 4 renal receptors were transplanted in the same donor hospital, all of which presented delayed graft function, requiring post-transplant haemodialysis in 3, but with favorable outcome in all.
It can be concluded that CMD is a good alternative in cases that do not evolve to death.
This was not adversely affected since both cases did not evolve to death and dying if they had not had the donation protocol in controlled asystole.
Rapid surgery should be included in these protocols as a good alternative for selected cases.
1.
J.J. Rubio, I. Fernández, A. Ortega, I. Lipperheide, M. Pérez and R. Siljeström Intensive Care Service Hdaierro Madrid, Spain
