Multiorgan donor and transplant patients

Abstract

Worldwide, physicians have made considerable effort to increase the number of transplants under the circumstances of an extremely severe organ donor shortage. In this setting, the role of the intensivist is usually of pivotal importance. The finding of an ineffective cardiac function should alert the clinician in order to better investigate the availability of other potential grafts. From the clinical decision perspective, the role of echocardiography prior to graft harvesting seems to be fundamental if there is suspect of left ventricular dysfunction in the donor: Left ventricular dysfunction is a common finding in patients with intracranial disorders (about 20 %), with the singular feature of regional wall abnormalities covering multiple coronary territories without and with underlying coronary disease. An expert operator can obtain a good preoperative evaluation with a 5-10-min standard examination. For evaluation of direct graft damage, the examination should exclude a direct lesion of heart structures. Intraoperative echocardiography has become a standard procedure during heart transplant. It can aid in identifying intracardiac thrombosis and a real-time assessment of the cardiac allograft during deairing, weaning from cardiopulmonary bypass, and after implantation of the donor heart as the chest is closed. Biventricular function, especially right ventricular function, valve function, and surgical anastomoses should always be assessed. Owing to the close interrelation between the heart and the lung, the evaluation by transesophageal echocardiography (TEE) is considered an invaluable tool for intraoperative monitoring during anesthesia for lung transplant. Induction and mechanical ventilation can exacerbate a preexisting pulmonary hypertension, leading to acute right ventricular failure. TEE is the right tool to inform the anesthesiologist about the necessity of extracorporeal intraoperative support. It can undoubtedly be stated that TEE is a fundamental tool for both standard monitoring and diagnosis in the transplant surgery environment.