The incessant development of transplant programs recorded in the last 20 years has determined the urgency to organize an organ procurement system that allows diagnosis, reporting, and maintenance of a potential donor. All patients whose neurologic condition deteriorates to where they no longer have demonstrable vegetative function must be considered as potential donors and undergo tests to determine conclusively the existence of brain death. Critical care units have been forced to meet new objectives in their regular work, especially those that involve the replacement of the vegetative functions of a human being who has been given this diagnosis and therefore is legally and biologically dead.
Brain death involves an immediate and progressive deterioration of all somatic functions; cardiac arrest after failure to maintain hemodynamic variables occurs within 48 to 72 hours (although in children this may take longer). Therefore, the possibility of transplanting organs whose viability depends on proper perfusion requires strict care so that irreversible damage does not occur once the diagnosis of brain death has been established. Careful management of mechanical ventilation and hemodynamic support, with the use of expanders and vasoactive drugs, is the major measure to be implemented in the support of a potential organ donor.
Identifying potential donors and their appropriate maintenance is the first step to obtaining high-quality organs. This is carried out by an independent organization, separate from the professionals that carry out the implant of the organs recovered, which in our country is the Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), which is equivalent to the United Network for Organ Sharing (UNOS) in the United States.
The new regulation imposed by the INCUCAI since 2006 provides that any competent person above 18 years old automatically becomes an organ and tissue donor after death, unless the refusal to do so has already been expressed. This policy is known as presumed donor. In addition, a family member must agree to the organ donation. This relativizes the policy, because if the family refuses, even if the donor has not refused organ donation, the organs cannot be harvested. The purpose of this statement relies on the fact that the allocation system must not be suspected of retrieving allografts without any disagreement, and thus is not distrusted.
The shortage of cadaveric donors, which has produced an increase in the retention and mortality of patients on the waiting list, determines the relevance of their optimal use. There is an urgent need for knowledge related to the systematic removal of organs by the entire medical community and the harmonious coordination of all actors involved in the removal of the organs available from a donor.
Detecting potential donors is a complicated process that requires the full cooperation of health personnel. Briefly, the definition of brain death is the irreversible cessation of all functions of the brainstem, ...