Dialyzing Brain Dead
- Hemodialysis: Case Reports, Series, QI Projects
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 801 Dialysis: Hemodialysis and Frequent Dialysis
- Munjal, Ripudaman Singh, San Joaquin General Hospital, French Camp, California, United States
- Sharma, Pranjal, Northeast Ohio Medical University, Rootstown, Ohio, United States
- Grewal, Harpreet S., Sacred Heart Hospital, Pensacola, Florida, United States
- Dhillon, Gagandeep, University of Maryland Baltimore, Baltimore, Maryland, United States
- Kashyap, Rahul, WellSpan Health, York, Pennsylvania, United States
Organ transplantation has been increasing worldwide, many of the patients die on wait list. The clinical progression of hemodynamic instability after brain death leads to possible loss of organs that could be harvested. Here we present a case of a twenty-six-year-old male who received kidney replacement therapy after being declared brain dead and was able to successfully donate his organs as per his organ donation status.
A twenty-six-year-old male admitted after a motor vehicle accident, was found to have multiple fatal injuries including intracranial hemorrhage. Unfortunately, he succumbed to his injuries and was declared brain dead. He subsequently developed oliguric acute kidney injury (AKI) due to acute tubular necrosis as noted on urine sediment with muddy brown casts, leading to volume overload and hyperkalemia. Nephrology was consulted for stabilization before organs could be procured. Patient was started on Extracorporeal Kidney-Replacement Therapy in the form of Sustained low-efficiency dialysis (SLED). Continuous kidney replacement therapy (CKRT) might have been a preferred option, but due to non-availability of CKRT at our center SLED was initiated. SLED was done to minimize the hemodynamic changes. The heart and left kidney were evetually procured and successfully transplanted. Family played an important role in deceased organ procurement and helped with every manner.
Nearly half of discarded kidneys from 2010-2020 were from donors with AKI. Management of organ donor with AKI is often curtailed due to hemodynamic and electrolyte instability. Dialysis can correct the effects of AKI, but is rarely started after brain-death. Extracorporeal kidney-replacement therapy following brain death has not been extensively explored, CKRT has been studied to some extent. Brain dead patients with AKI treated CKRT have a favorable outcomes in organ donation. At our center, a brain-dead patient received dialysis in the form of SLED which improved hyperkalemia and volume overload, enabling the successful organ procurement. There is a need for further investigation into dialysis after death for organ procurement. Any intervention or treatment provided after death creates an ethical dilemma. There is a need to examine the ethical considerations and guidelines around the use of extra-corporeal kidney replacement therapy in brain dead patients for organ procurement.