Optimizing Organ Donation After Euthanasia: A Critical Appraisal

Transplantology, vol. 6, pp. 10

Abstract

This Critical Appraisal aims to explore the pharmacokinetics and pharmacodynamics of medications used in organ donors after euthanasia (ODE) and their impact on abdominal organ quality. With the legalization of ODE, the donor pool has expanded, but it has introduced complexities regarding organ quality. This study evaluates existing euthanasia protocols in the Netherlands, Belgium, Spain, and Canada, focusing on differences in the medication types and dosages. Additionally, a literature review assessed the potential hepatotoxic effects of high-dose medications like thiopental, propofol, and non-depolarizing neuromuscular blocking agents. High doses of non-depolarizing neuromuscular blocking agents, particularly rocuronium, are associated with hepatotoxic effects in vitro. Furthermore, thiopental doses exceeding 750 mg significantly increase the risk of liver dysfunction. Recent findings also indicate that high-dose propofol and lidocaine can slightly prolong the time to death, which is crucial for optimizing organ viability in ODE. This study highlights the need to optimize organ donation procedures after euthanasia. Further research is needed to achieve this balance, maintaining the integrity and ethical standards of the euthanasia process while enhancing the outcomes of organ donation.

Authors 7

1. E. A. J. Alkemade corresponding Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, 2333 ZA Leiden, The Netherlands

2. Hwai‐Ding Lam Aachen Abdominal Organ Transplant Centre Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Abdominal Organ Transplant Centre, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands

3. Bart J. C. Hendriks Aachen Department of Clinical Pharmacy and Toxicology

   Leiden University Medical Center

   Affiliation as printed

   Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands

4. Andries Erik Braat Aachen Abdominal Organ Transplant Centre Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Abdominal Organ Transplant Centre, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands

5. Ian P.J. Alwayn Aachen Abdominal Organ Transplant Centre Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Abdominal Organ Transplant Centre, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands

6. Minneke J. Coenraad Aachen Department of Gastroenterology and Hepatology

   Leiden University Medical Center

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands

7. Andrzej G Baranski corresponding Aachen Abdominal Organ Transplant Centre Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Abdominal Organ Transplant Centre, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands