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Goals
of donor maintenance
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The
following goals are to be achieved while maintaining a
potential cadaveric donor to ensure the successful harvesting
of a viable organ.
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- Maintain
kidney functions.
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-
Keep
systolic blood pressure above 100 mmHg for adults by:
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Volume
Expansion
Rehydrate the patient as needed.
Central venous pressure should be kept more
than 8 cm H2O.
-
Use of vasopressors if needed.
Dopamine
is the drug of choice. Wean
the patient as the blood pressure stabilizes.
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Maintain urinary output of 80-100 cc per
hour. Intake
should be kept well balanced with total output.
If CVP is greater than 12 cm H2O, furosemide may be
used.
-
The electrolytes and
acid-base status of the potential donor should be kept within
the normal range. Attention
should be given to avoid hypernatremia (serum Na+ > 150
mmol/1), hypokalemia (serum K+ <3.5 mmol/1) and acidosis.
Serum HCO3- should be kept above 20 mmol/l.
-
Watch for diabetes
insipidus which is a common complication of brain death due
to loss of regulatory function of the osmoreceptors and is
associated with hypernatremia and hypokalemia.
If fluid
replacement (with dextrose alone) does not reduce serum sodium
and if the amount of urine production is more than 500-700
cc/hour, give 4 units of pitressin subcutaneously. Repeat this if needed, q 4-6 hourly.
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Attention should be given to prevent hypoxia,
acidosis and infection.
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Maintain normal temperature.
May need to use cooling or warming blankets as
necessary.
-
Resuscitate promptly in the event of a cardiac
arrest if the brain-dead patient is a potential organ donor.
-
Maintain life support systems until the time of harvesting of
organs.
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RELIGIOUS
ASPECTS OF ORGAN TRANSPLANT
Purport
of the Senior Ulama Commission's
Decision
No. 99 dated 6/11/1402 H (25/09/1982 G).
The
board unanimously resolved the permissibility to remove an
organ, or a part thereof from a Moslem or Thimmi living person
and graft it onto himself, should the need arise, should there
be no harm in the removal and should the transplantation seem
likely successful.
The
board also resolved, by majority, the following:
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The permissibility to remove an
organ or part thereof from a dead person for the benefit of a
Moslem, should the need arise and should the removal cause no
dissatisfaction and should the transplantation seem likely
successful.
-
The permissibility for the living
person to donate one of his organs or a part thereof for the
benefit of a Moslem in need thereof.
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"RESOLUTION
OF THE COUNCIL OF ISLAMIC
JURISPRUDENCE
ON RESUSCITATION APPARATUS"
Amman,
1407 H (1986 G) No.86-07-3D (5)
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The
Council of Islamic Jurisprudence academy in its third session
held in Amman 13-02-1407 H (16-10-1986 G) discussed the
supportive means in intensive care units and after
comprehensive explanation from consultant doctors decided the
following:
The
Person is considered legally dead, and all the Shariah
principles of death apply if one of the following conditions
is confirmed.
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Complete cessation of the heart and respiration, and the
doctors have ruled that the cessation is irreversible.
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Complete cessation of all functions
of the brain and the consultant doctors have ruled that
the cessation is irreversible, and the brain has started to
degenerate.
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In
this condition there is permissibility to discontinue the
supportive means from the patient even if some of his organs,
like heart, still work artificially.
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