Letter to the Editor
Organ donor management: Common recommendations that deserve evidence
Mantenimiento del donante de órganos: recomendaciones generales que precisan evidencia
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Gil-Salazar, J.J. Egea-Guerrero, L. Martin-Villen, Z. Ruiz de Azua-López" "autores" => array:4 [ 0 => array:3 [ "nombre" => "T." "apellidos" => "Gil-Salazar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "J.J." "apellidos" => "Egea-Guerrero" "email" => array:2 [ 0 => "jjegeaguerrero@gmail.com" 1 => "juanj.egea.sspa@juntadeandalucia.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Martin-Villen" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Z." "apellidos" => "Ruiz de Azua-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Trasplantes, Fundación Valle Del Lili, Cali, Valle del Cauca, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mantenimiento del donante de órganos: recomendaciones generales que precisan evidencia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">After reading Chamorro-Jambrina et al.’s review<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> we agree with the authors that the adequate maintenance of potential donors is essential to guarantee the viability of those organs suitable for transplant.</p><p id="par0010" class="elsevierStylePara elsevierViewall">However, we think it is important to say that although such recommendations are usually brought up in different reviews on the maintenance of potential donors, there is still no scientific evidence on these recommendations. In particular, we are talking about the optimal hemoglobin level to start transfusing a potential donor. In theory, by default, and extrapolated to the critically ill patient levels of 7<span class="elsevierStyleHsp" style=""></span>g/dL are considered the rule of thumb here.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In other classical reviews, hematocrit levels <30% are indicative of transfusion.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> As far as we know, no study validates such recommendation. Unfortunately, the very few studies conducted on this regard never included such recommendation in their maintenance goals.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> All this becomes more complex when dealing with potential donors in asystole, although we understand that this exceeds the authors’ original review.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Another controversial fact is the administration of enteral nutrition to potential donors. Hergenroeder et al. reported that up to 30% of potential brain-dead donors are capable of absorbing enteral nutrition.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Other authors even say that the use of enteral nutrition is beneficial for maintaining the integrity of intestinal mucosa and reducing the rates of pneumonia and other infections such as intestinal bacterial translocation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Therefore, we do not think it is fully appropriate to say that enteral nutrition should not be maintained as Chamorro-Jambrina et al. claim.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In sum, despite the high level of expertise in the management of potential donors in intensive care units, and the huge experience accumulated on this regard, such as the facts described above, well-designed clinical trials should be conducted in order to establish enough scientific evidence as to give recommendations in each and every one of these clinical conditions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-15" "fechaAceptado" => "2018-02-24" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gil-Salazar T, Egea-Guerrero JJ, Martin-Villen L, Ruiz de Azua-López Z. Mantenimiento del donante de órganos: recomendaciones generales que precisan evidencia. Med Intensiva. 2018;42:513.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Organ donor management: eight common recommendations and actions that deserve reflection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Chamorro-Jambrina" 1 => "M.R. Muñoz-Ramírez" 2 => "J.L. Martínez-Melgar" 3 => "M.S. Pérez-Cornejo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2017.01.012" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2017" "volumen" => "41" "paginaInicial" => "559" "paginaFinal" => "568" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28318674" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Care of the potential organ donor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E.W. Kenneth" 1 => "B.N. Bryan" 2 => "J.G. McCartney" 3 => "A.M. D’Alessandro" 4 => "B.D. Coursin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra013103" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "2004" "volumen" => "351" "paginaInicial" => "2730" "paginaFinal" => "2739" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15616207" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204518300299" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of meeting donor management goals on the number of organs transplanted per donor: Results from the united network for Organ Sharing region 5 prospective donor management goals study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "UNOS Region 5 DMG workgroup" "etal" => false "autores" => array:5 [ 0 => "D.J. Malinoski" 1 => "M.S. Patel" 2 => "M.C. Daly" 3 => "C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 4 | 6 |
| 2024 October | 48 | 53 | 101 |
| 2024 September | 35 | 29 | 64 |
| 2024 August | 54 | 45 | 99 |
| 2024 July | 34 | 21 | 55 |
| 2024 June | 41 | 35 | 76 |
| 2024 May | 41 | 36 | 77 |
| 2024 April | 49 | 33 | 82 |
| 2024 March | 37 | 22 | 59 |
| 2024 February | 34 | 41 | 75 |
| 2024 January | 26 | 34 | 60 |
| 2023 December | 25 | 27 | 52 |
| 2023 November | 38 | 26 | 64 |
| 2023 October | 22 | 30 | 52 |
| 2023 September | 31 | 37 | 68 |
| 2023 August | 26 | 12 | 38 |
| 2023 July | 18 | 26 | 44 |
| 2023 June | 11 | 15 | 26 |
| 2023 May | 37 | 30 | 67 |
| 2023 April | 27 | 15 | 42 |
| 2023 March | 37 | 22 | 59 |
| 2023 February | 45 | 34 | 79 |
| 2023 January | 23 | 16 | 39 |
| 2022 December | 39 | 22 | 61 |
| 2022 November | 43 | 33 | 76 |
| 2022 October | 50 | 22 | 72 |
| 2022 September | 31 | 38 | 69 |
| 2022 August | 29 | 39 | 68 |
| 2022 July | 30 | 33 | 63 |
| 2022 June | 27 | 26 | 53 |
| 2022 May | 33 | 32 | 65 |
| 2022 April | 31 | 50 | 81 |
| 2022 March | 45 | 51 | 96 |
| 2022 February | 28 | 29 | 57 |
| 2022 January | 40 | 31 | 71 |
| 2021 December | 52 | 43 | 95 |
| 2021 November | 37 | 38 | 75 |
| 2021 October | 45 | 71 | 116 |
| 2021 September | 33 | 35 | 68 |
| 2021 August | 21 | 22 | 43 |
| 2021 July | 24 | 27 | 51 |
| 2021 June | 25 | 27 | 52 |
| 2021 May | 40 | 41 | 81 |
| 2021 April | 65 | 70 | 135 |
| 2021 March | 66 | 23 | 89 |
| 2021 February | 62 | 27 | 89 |
| 2021 January | 42 | 18 | 60 |
| 2020 December | 39 | 12 | 51 |
| 2020 November | 37 | 19 | 56 |
| 2020 October | 26 | 35 | 61 |
| 2020 September | 31 | 20 | 51 |
| 2020 August | 26 | 22 | 48 |
| 2020 July | 24 | 24 | 48 |
| 2020 June | 28 | 14 | 42 |
| 2020 May | 25 | 7 | 32 |
| 2020 April | 16 | 9 | 25 |
| 2020 March | 15 | 9 | 24 |
| 2020 February | 30 | 45 | 75 |
| 2020 January | 34 | 20 | 54 |
| 2019 December | 23 | 15 | 38 |
| 2019 November | 16 | 17 | 33 |
| 2019 October | 26 | 21 | 47 |
| 2019 September | 31 | 17 | 48 |
| 2019 August | 28 | 21 | 49 |
| 2019 July | 38 | 20 | 58 |
| 2019 June | 17 | 9 | 26 |
| 2019 May | 40 | 38 | 78 |
| 2019 April | 21 | 13 | 34 |
| 2019 March | 17 | 16 | 33 |
| 2019 February | 0 | 9 | 9 |
| 2019 January | 0 | 5 | 5 |
| 2018 December | 1 | 0 | 1 |
| 2018 October | 2 | 2 | 4 |
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