The Effect of Goal-Directed Protocols for the Management of Brain-Dead Potential Organ Donors: An Integrative Review After Meta-Analysis

Abstract

The management of brain-dead potential organ donors is critical in the process of organ donation, and the implementation of goal-oriented protocols can optimize outcomes. The aim of this review was to critically explore the main publications that evaluated the impact of multifaceted goal-guided protocols for the management of potential organ donors on outcomes. This integrative review analyzed the effect measures of the studies that were selected and critically evaluated according to their respective designs. The quality of each study was independently graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The studies were divided into four subgroups according to the outcomes analyzed: number of organs recovered per donor, number of organs transplanted per donor, losses of brain-dead potential donors due to cardiovascular collapse, and primary renal graft dysfunction. Among 2888 articles identified in the initial search, 18 were selected. Multifaceted goal-guided protocols were associated with a larger number of recovered and transplanted organs, fewer donor losses due to cardiovascular collapse, and less primary graft dysfunction. The following goals were related to better outcomes: mean arterial pressure ≥ 65 mmHg, ≤ 1 vasopressor, vasopressin, thyroid hormone, pH 7.3–7.5, PaO₂/FiO₂ ≥ 300, sodium < 155 mEq/L, and blood glucose ≤ 180 mg/dL. We observed a positive association between the adoption of multifaceted goal-directed protocols for the management of brain-dead potential organ donors and the outcomes analyzed. The limitations of the already published studies highlight the need for further investigation of the gaps in existing information on the subject.