0
April 21, 1989, Vol 261, No. 15 >
ARTICLE | April 21, 1989

Approach to Management of the Heartbeating `Brain Dead' Organ Donor FREE

Joseph M. Darby, MD; Keith Stein, MD; Ake Grenvik, MD, PhD; Susan A. Stuart, RN
[+] Author Affiliations

Reprint requests to Division of Critical Care Medicine, 1323 Presbyterian-University Hospital, Pittsburgh, PA 15213 (Dr Darby).


JAMA. 1989;261(15):2222-2228. doi:10.1001/jama.1989.03420150072040
Text Size: A A A
Published online
Article
References

In recent years, transplantation has assumed an important role in the treatment of patients with end-stage diseases of most major organ systems. However, the greatest limitation in organ transplantation today is organ supply. Among factors that can affect the organ supply favorably, donor management has received the least attention. This review addresses management of the multi-organ donor within the intensive care unit. With an increased awareness of donor management issues and the application of a rational physiological approach, the supply of functional organs for transplantation can be increased.

(JAMA. 1989;261:2222-2228)

REFERENCES

1 +
Stuart FP.  Need, supply and legal issues related to organ transplantation in the United States . Transplant Proc. 1984;;16:87-94.
2 +
Merz B.  The organ procurement problem: many causes, no easy solutions . JAMA. 1985;;254:3285-3288.
3 +
Evans RW, Manninen DL, Garrison LP, Maier AM.  Donor availability as the primary determinant of the future of heart transplantation . JAMA. 1986;;255:1892-1898.
4 +
Broznick BA.  Organ procurement: fulfilling a need . Transplant Proc. 1988;;20( (suppl 1) ):1010.
5 +
Bart KJ, Macon EJ, Humphries AL, et al.  Increasing the supply of cadaveric kidneys for transplantation . Transplantation. 1981;;31:383-387.
6 +
Tolle SW, Bennett WM, Hickam DH, Benson JA.  Responsibilities of primary physicians in organ donation . Ann Intern Med. 1987;;106:740-744.
7 +
Emery RW, Cork RC, Levinson MM, et al.  The cardiac donor: a six-year experience . Ann Thorac Surg. 1986;;41:356-362.
8 +
Stark JL, Reiley P, Osiecki A, Cook L.  Attitudes affecting organ donation in the intensive care unit . Heart Lung. 1984;;13:400-404.
9 +
Bart KJ, Macon EJ, Humpries AL.  A response to the shortage of cadaveric kidneys for transplantation . Transplant Proc. 1979;;11:455-458.
10 +
Davis FD.  Coordination of cardiac transplantation: patient processing and donor organ procurement . Circulation. 1987;;75:29-39.
11 +
Cecka JM.  Donor factors . In: Teraski P, ed. Clinical Transplants 1987 . Los Angeles, Calif: UCLA Tissue Typing Laboratory; 1987;:423-434.
12 +
Kormos RL, Donato W, Hardesty RL, Griffith BP, Kiernan J, Trento A.  The influence of donor organ stability and ischemia time on subsequent cardiac recipient survival . Transplant Proc. 1988;;20( (suppl 1) ):980-983.
13 +
Lucas BA, Baughn WK, Spees EK, Sanfillipo F.  Identification of donor factors predisposing to high discard rates of cadaver kidneys and increased graft loss within one year post transplantation: SEOPF 1977-1982 . Transplantation. 1987;;43:253-258.
14 +
Hardesty RL, Griffith BP.  Multiple cadaveric organ procurement for transplantation with emphasis on the heart . Surg Clin North Am. 1986;;66:451-457.
15 +
Raftery AT, Johnson RWG.  Dopamine pretreatment in unstable kidney donors . Br Med J. 1979;;87:522.
16 +
Van der Vliet JA, Tidow G, Kootstra G, et al.  Transplantation of contaminated organs . Br J Surg. 1980;;167:596-598.
17 +
Slapak M.  The immediate care of potential donors for cadaveric organ transplantation . Anesthesia. 1978;;33:700-709.
18 +
Schuler S, Warnecke H, Wagner K, Hetzer R.  Extended donor criteria for heart transplantation . J Heart Transplant. 1986;;5:375.
19 +
Harjula A, Starnes VA, Oyer PE, Jamieson SW, Shumway NE.  Proper donor selection for heart-lung transplantation . J Thorac Cardiovasc Surg. 1987;;94:874-880.
20 +
Szmidt J, Karolak T, Sablinski T, et al.  Transplantation of kidneys harvested from donors over sixty years of age . Transplant Proc. 1988;;20:772.
21 +
Klintmalm GBG.  The liver donor: special consideration . Transplant Proc. 1988;;20( (suppl 7) ):9-11.
22 +
Griepp RB, Stinson EB, Clark DA, Dong E, Shumway NE.  The cardiac donor . Surg Gynecol Obstet. 1971;;133:792-798.
23 +
Novitzky D, Cooper DKC, Reichart B.  Hemodynamic and metabolic responses to hormonal therapy in brain dead potential organ donors . Transplantation. 1987;;43:852-854.
24 +
Copeland JG, Emery RW, Levinson MM, et al.  Selection of patients for cardiac transplantation . Circulation. 1987;;75:2-9.
25 +
Renlund DG, Bristow MR, Lee HR, O'Connell JB.  Medical aspects of cardiac transplantation . J Cardiothorac Anesth. 1988;;2:500-512.
26 +
Tenzer ML.  The spectrum of myocardial contusion: a review . J Trauma. 1985;;25:620-627.
27 +
Tarazi RY, Bonser RS, Jamieson SW.  Heart-lung transplantation . In: Gallagher TJ, ed. Critical Care State of the Art . Fullerton, Calif: Society of Critical Care Medicine; 1988;:55-72.
28 +
Todd RJ.  Pulmonary transplantation . In: Gallagher TJ, ed. Critical Care State of the Art . Fullerton, Calif: Society of Critical Care Medicine; 1988;:41-53.
29 +
The Toronto Lung Transplant Group.  Experience with single-lung transplantation for pulmonary fibrosis . JAMA . 1988;;259;2258-2262.
30 +
Makowka L, Gordon RD, Todo S, et al.  Analysis of donor criteria for the prediction of outcome in clinical liver transplantation . Transplant Proc. 1987;;19:2378-2382.
31 +
Stock PG, Najarian JS, Ascher NL.  Liver transplantation . In: Gallagher TJ, ed. Critical Care State of the Art . Fullerton, Calif: Society of Critical Care Medicine; 1988;:21-24.
32 +
Burdelski M, Oellerich M, Raude E, et al.  A novel approach to assessment of liver function in donors . Transplant Proc. 1988;;20( (suppl 1) ):591-593.
33 +
Hesse UJ, Najarian JS, Sutherland DER.  Amylase activity and pancreas transplants . Lancet. 1985;;2:726.
34 +
Chatterjee SN, Payne JE, Berke TV.  Difficulties in obtaining kidneys from potential postmortum donors . JAMA. 1975;;232:822-824.
35 +
 Report of the medical consultants on the diagnosis of death to the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: guidelines for the determination of death . JAMA. 1981;;246:2184-2186.
36 +
Task Force for the Determination of Brain Death in Children.  Guidelines for the determination of brain death in children . Ann Neurol. 1987;;21:616-617.
37 +
Powner DJ.  The diagnosis of brain death in the adult patient . J Intensive Care Med. 1987;;2:181-189.
38 +
Belsh JM, Blatt R, Schiffman PL.  Apnea testing in brain death . Arch Intern Med. 1986;;146:2385-2388.
39 +
Coulter DL.  Neurologic uncertainty in newborn intensive care . N Engl J Med. 1987;;316:840-844.
40 +
Novitzky D, Wicomb WN, Cooper DKC, Rose AG, Fraser RC, Barnard CN.  Electrocardiographic, hemodynamic and endocrine changes occurring during experimental brain death in the Chacma baboon . J Heart Transplant. 1984;;4:63-69.
41 +
Novitzky D, Wicomb WN, Cooper DKC, Rose AG, Reichart B.  Prevention of myocardial injury during brain death by total cardiac sympathectomy in the Chacma baboon . Ann Thorac Surg. 1986;;41:520-524.
42 +
Macoviak JA, McDougall IR, Bayer MF, Brown M, Tazelaar H, Stinson EB.  Significance of thyroid dysfunction in human cardiac allograft procurement . Transplantation. 1987;;43:24-826.
43 +
 Esmolol: a short-acting IV beta-blocker . Med Lett Drugs Ther. 1987;;29:57-58.
44 +
Wicomb WN, Cooper DKC, Lanza RP, Novitzky D, Isaacs S.  The effects of brain death and 24 hours storage by hypothermic perfusion on donor heart function in the pig . J Thorac Cardiovasc Surg. 1986;;91:896-909.
45 +
Flanigan WJ, Ardon LF, Brewer TE, Caldwell FT.  Etiology and diagnosis of early post-transplantation oliguria . Am J Surg. 1976;;132:808-815.
46 +
Toledo-Pereyra LH, Simmons RL, Olson LC, Najarian JS.  Cadaver kidney transplantation effect of hypotension and donor pretreatment with methyleprednisolone and phenoxybenzamine . Minn Med. 1979;;62:159-161.
47 +
Whelchel JD, Diethelm AG, Phillips MG, Rhyder WR, Schein LG.  The effect of high-dose dopamine in cadaver donor management on delayed graft function and graft survival following renal transplantation . Transplant Proc. 1986;;18;523-527.
48 +
Busuttil RW, Goldstein LI, Danovitch GM, Ament ME.  Liver transplantation today . Ann Intern Med. 1986;;104:377-389.
49 +
Schneider A, Toledo-Pereyra LH, Zeichner WD, Allaben R, Whitten J.  Effect of dopamine and pitressin on kidneys procured and harvested for transplantation . Transplantation. 1982;;36:110-111.
50 +
Levinson MM, Copeland J.  The organ donor: physiology, maintenance, and procurement considerations . In: Brown RB, ed. Anesthesia and Transplantation Surgery . Philadelphia, Pa: FA Davis Co Publishers; 1987;:31-45.
51 +
Jeekel J, Harder F, Persijn GG, Brynger H, Marquet RL.  Beneficial effect of blood transfusion to the donor on kidney graft in man: a study in three centers . Transplant Proc. 1983;;15:973-975.
52 +
Outwater KM, Rockoff MA.  Diabetes insipidus accompanying brain death in children . Neurology. 1984;;34:1243-1246.
53 +
Fiser DH, Jimenez JF, Wrape V, Woody R.  Diabetes insipidus in children with brain death . Crit Care Med. 1987;;15:551-553.
54 +
Richardson DW, Robinson AG.  Desmopressin . Ann Intern Med. 1985;;103:228-239.
55 +
Richardson PDI, Witherington PG.  Liver blood flow, II: Effects of drugs on hormones in liver blood flow . Gastroenterology. 1981;;81:356-375.
56 +
Cowley AW, Monos E, Guyton AC.  Interaction of vasopressin and the baroreceptor reflex system in the regulation of arterial blood pressure in the dog . Circ Res. 1974;;34:505-514.
57 +
Yosioka T, Sugimoto H, Uenishi M, et al:  Prolonged hemodynamic maintenance by the combined administration of vasopressin and epinephrine in brain death: a clinical study . Neurosurgery. 1986;;18:565-567.
58 +
Davis S, Olichwier KK, Chakko SC.  Reversible depression of myocardial performance in hypophosphatemia . Am J Med Sci. 1988;;295:183-187.
59 +
Baldwin TE, Chernow B.  Hypocalcemia in the ICU: coping with the causes and consequences . J Crit Ill. 1987;;2:9-16.
60 +
Kroncke GM, Nichols RD, Mendenhall JT, Meyerowitz PD, Starling JR.  Ectothermic philosophy of acid-base balance to prevent fibrillation during hypothermia . Arch Surg. 1986;;121:303-304.
61 +
Swain JA.  Hypothermia and blood pH: a review . Arch Intern Med. 1988;;148:1643-1646.
62 +
White FN.  A comparative physiological approach to hypothermia . J Thorac Cardiovasc Surg. 1981;;82:821-831.
63 +
Jarnberg P-O, DeVillota DE, Eklund J, Granberg P-O.  Effects of positive end-expiratory pressure on renal function . Acta Anaesthesiol Scand. 1978;;22:508-514.
64 +
Matuschak GM, Pinsky MR, Rogers RM.  Effects of positive end-expiratory pressure on hepatic blood flow and performance . J Appl Physiol. 1987;;62:1377-1383.
65 +
Curley FJ, Irwin RS.  Disorders of temperature control: hypothermia, part III . J Intensive Care Med. 1986;;1:270-288.
66 +
Kaufman HH, Hui KS, Mattson JC, et al.  Clinicopathologic correlations of disseminated intravascular coagulation in patients with severe head injury . Neurosurgery. 1984;;15:34-42.
67 +
Gifford RRM, Weaver AS, Burg JE, Romano PJ, Demers LM, Pennock JL.  Thyroid hormone levels in heart and kidney cadaver donors . J Heart Transplant. 1986;;5:49-253.
68 +
Wahlers T, Fieguth HG, Jurmann M, et al.  Does hormone depletion of organ donors impair myocardial function after cardiac transplantation? Transplant Proc. 1988;;20( (suppl 1) ):792-794.
69 +
Novitzky D, Wicomb WN, Cooper DKC, Tjaalgard MA.  Improved cardiac function following hormonal therapy in brain dead pigs: relevence to organ donation . Cryobiology. 1987;;24:1.
70 +
Wicomb WN, Cooper DKC, Novitzky D.  Impairment of renal slice function following brain death, with reversability of injury by hormonal therapy . Transplantation. 1986;;41:29-33.
71 +
Novitzky D, Cooper DKC, Morrell D, Isaacs S.  Change from aerobic to anerobic metabolism after brain death, and reversal following triodothyronine therapy . Transplantation. 1988;;45:32-36.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Stuart FP.  Need, supply and legal issues related to organ transplantation in the United States . Transplant Proc. 1984;;16:87-94.
2 +
Merz B.  The organ procurement problem: many causes, no easy solutions . JAMA. 1985;;254:3285-3288.
3 +
Evans RW, Manninen DL, Garrison LP, Maier AM.  Donor availability as the primary determinant of the future of heart transplantation . JAMA. 1986;;255:1892-1898.
4 +
Broznick BA.  Organ procurement: fulfilling a need . Transplant Proc. 1988;;20( (suppl 1) ):1010.
5 +
Bart KJ, Macon EJ, Humphries AL, et al.  Increasing the supply of cadaveric kidneys for transplantation . Transplantation. 1981;;31:383-387.
6 +
Tolle SW, Bennett WM, Hickam DH, Benson JA.  Responsibilities of primary physicians in organ donation . Ann Intern Med. 1987;;106:740-744.
7 +
Emery RW, Cork RC, Levinson MM, et al.  The cardiac donor: a six-year experience . Ann Thorac Surg. 1986;;41:356-362.
8 +
Stark JL, Reiley P, Osiecki A, Cook L.  Attitudes affecting organ donation in the intensive care unit . Heart Lung. 1984;;13:400-404.
9 +
Bart KJ, Macon EJ, Humpries AL.  A response to the shortage of cadaveric kidneys for transplantation . Transplant Proc. 1979;;11:455-458.
10 +
Davis FD.  Coordination of cardiac transplantation: patient processing and donor organ procurement . Circulation. 1987;;75:29-39.
11 +
Cecka JM.  Donor factors . In: Teraski P, ed. Clinical Transplants 1987 . Los Angeles, Calif: UCLA Tissue Typing Laboratory; 1987;:423-434.
12 +
Kormos RL, Donato W, Hardesty RL, Griffith BP, Kiernan J, Trento A.  The influence of donor organ stability and ischemia time on subsequent cardiac recipient survival . Transplant Proc. 1988;;20( (suppl 1) ):980-983.
13 +
Lucas BA, Baughn WK, Spees EK, Sanfillipo F.  Identification of donor factors predisposing to high discard rates of cadaver kidneys and increased graft loss within one year post transplantation: SEOPF 1977-1982 . Transplantation. 1987;;43:253-258.
14 +
Hardesty RL, Griffith BP.  Multiple cadaveric organ procurement for transplantation with emphasis on the heart . Surg Clin North Am. 1986;;66:451-457.
15 +
Raftery AT, Johnson RWG.  Dopamine pretreatment in unstable kidney donors . Br Med J. 1979;;87:522.
16 +
Van der Vliet JA, Tidow G, Kootstra G, et al.  Transplantation of contaminated organs . Br J Surg. 1980;;167:596-598.
17 +
Slapak M.  The immediate care of potential donors for cadaveric organ transplantation . Anesthesia. 1978;;33:700-709.
18 +
Schuler S, Warnecke H, Wagner K, Hetzer R.  Extended donor criteria for heart transplantation . J Heart Transplant. 1986;;5:375.
19 +
Harjula A, Starnes VA, Oyer PE, Jamieson SW, Shumway NE.  Proper donor selection for heart-lung transplantation . J Thorac Cardiovasc Surg. 1987;;94:874-880.
20 +
Szmidt J, Karolak T, Sablinski T, et al.  Transplantation of kidneys harvested from donors over sixty years of age . Transplant Proc. 1988;;20:772.
21 +
Klintmalm GBG.  The liver donor: special consideration . Transplant Proc. 1988;;20( (suppl 7) ):9-11.
22 +
Griepp RB, Stinson EB, Clark DA, Dong E, Shumway NE.  The cardiac donor . Surg Gynecol Obstet. 1971;;133:792-798.
23 +
Novitzky D, Cooper DKC, Reichart B.  Hemodynamic and metabolic responses to hormonal therapy in brain dead potential organ donors . Transplantation. 1987;;43:852-854.
24 +
Copeland JG, Emery RW, Levinson MM, et al.  Selection of patients for cardiac transplantation . Circulation. 1987;;75:2-9.
25 +
Renlund DG, Bristow MR, Lee HR, O'Connell JB.  Medical aspects of cardiac transplantation . J Cardiothorac Anesth. 1988;;2:500-512.
26 +
Tenzer ML.  The spectrum of myocardial contusion: a review . J Trauma. 1985;;25:620-627.
27 +
Tarazi RY, Bonser RS, Jamieson SW.  Heart-lung transplantation . In: Gallagher TJ, ed. Critical Care State of the Art . Fullerton, Calif: Society of Critical Care Medicine; 1988;:55-72.
28 +
Todd RJ.  Pulmonary transplantation . In: Gallagher TJ, ed. Critical Care State of the Art . Fullerton, Calif: Society of Critical Care Medicine; 1988;:41-53.
29 +
The Toronto Lung Transplant Group.  Experience with single-lung transplantation for pulmonary fibrosis . JAMA . 1988;;259;2258-2262.
30 +
Makowka L, Gordon RD, Todo S, et al.  Analysis of donor criteria for the prediction of outcome in clinical liver transplantation . Transplant Proc. 1987;;19:2378-2382.
31 +
Stock PG, Najarian JS, Ascher NL.  Liver transplantation . In: Gallagher TJ, ed. Critical Care State of the Art . Fullerton, Calif: Society of Critical Care Medicine; 1988;:21-24.
32 +
Burdelski M, Oellerich M, Raude E, et al.  A novel approach to assessment of liver function in donors . Transplant Proc. 1988;;20( (suppl 1) ):591-593.
33 +
Hesse UJ, Najarian JS, Sutherland DER.  Amylase activity and pancreas transplants . Lancet. 1985;;2:726.
34 +
Chatterjee SN, Payne JE, Berke TV.  Difficulties in obtaining kidneys from potential postmortum donors . JAMA. 1975;;232:822-824.
35 +
 Report of the medical consultants on the diagnosis of death to the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: guidelines for the determination of death . JAMA. 1981;;246:2184-2186.
36 +
Task Force for the Determination of Brain Death in Children.  Guidelines for the determination of brain death in children . Ann Neurol. 1987;;21:616-617.
37 +
Powner DJ.  The diagnosis of brain death in the adult patient . J Intensive Care Med. 1987;;2:181-189.
38 +
Belsh JM, Blatt R, Schiffman PL.  Apnea testing in brain death . Arch Intern Med. 1986;;146:2385-2388.
39 +
Coulter DL.  Neurologic uncertainty in newborn intensive care . N Engl J Med. 1987;;316:840-844.
40 +
Novitzky D, Wicomb WN, Cooper DKC, Rose AG, Fraser RC, Barnard CN.  Electrocardiographic, hemodynamic and endocrine changes occurring during experimental brain death in the Chacma baboon . J Heart Transplant. 1984;;4:63-69.
41 +
Novitzky D, Wicomb WN, Cooper DKC, Rose AG, Reichart B.  Prevention of myocardial injury during brain death by total cardiac sympathectomy in the Chacma baboon . Ann Thorac Surg. 1986;;41:520-524.
42 +
Macoviak JA, McDougall IR, Bayer MF, Brown M, Tazelaar H, Stinson EB.  Significance of thyroid dysfunction in human cardiac allograft procurement . Transplantation. 1987;;43:24-826.
43 +
 Esmolol: a short-acting IV beta-blocker . Med Lett Drugs Ther. 1987;;29:57-58.
44 +
Wicomb WN, Cooper DKC, Lanza RP, Novitzky D, Isaacs S.  The effects of brain death and 24 hours storage by hypothermic perfusion on donor heart function in the pig . J Thorac Cardiovasc Surg. 1986;;91:896-909.
45 +
Flanigan WJ, Ardon LF, Brewer TE, Caldwell FT.  Etiology and diagnosis of early post-transplantation oliguria . Am J Surg. 1976;;132:808-815.
46 +
Toledo-Pereyra LH, Simmons RL, Olson LC, Najarian JS.  Cadaver kidney transplantation effect of hypotension and donor pretreatment with methyleprednisolone and phenoxybenzamine . Minn Med. 1979;;62:159-161.
47 +
Whelchel JD, Diethelm AG, Phillips MG, Rhyder WR, Schein LG.  The effect of high-dose dopamine in cadaver donor management on delayed graft function and graft survival following renal transplantation . Transplant Proc. 1986;;18;523-527.
48 +
Busuttil RW, Goldstein LI, Danovitch GM, Ament ME.  Liver transplantation today . Ann Intern Med. 1986;;104:377-389.
49 +
Schneider A, Toledo-Pereyra LH, Zeichner WD, Allaben R, Whitten J.  Effect of dopamine and pitressin on kidneys procured and harvested for transplantation . Transplantation. 1982;;36:110-111.
50 +
Levinson MM, Copeland J.  The organ donor: physiology, maintenance, and procurement considerations . In: Brown RB, ed. Anesthesia and Transplantation Surgery . Philadelphia, Pa: FA Davis Co Publishers; 1987;:31-45.
51 +
Jeekel J, Harder F, Persijn GG, Brynger H, Marquet RL.  Beneficial effect of blood transfusion to the donor on kidney graft in man: a study in three centers . Transplant Proc. 1983;;15:973-975.
52 +
Outwater KM, Rockoff MA.  Diabetes insipidus accompanying brain death in children . Neurology. 1984;;34:1243-1246.
53 +
Fiser DH, Jimenez JF, Wrape V, Woody R.  Diabetes insipidus in children with brain death . Crit Care Med. 1987;;15:551-553.
54 +
Richardson DW, Robinson AG.  Desmopressin . Ann Intern Med. 1985;;103:228-239.
55 +
Richardson PDI, Witherington PG.  Liver blood flow, II: Effects of drugs on hormones in liver blood flow . Gastroenterology. 1981;;81:356-375.
56 +
Cowley AW, Monos E, Guyton AC.  Interaction of vasopressin and the baroreceptor reflex system in the regulation of arterial blood pressure in the dog . Circ Res. 1974;;34:505-514.
57 +
Yosioka T, Sugimoto H, Uenishi M, et al:  Prolonged hemodynamic maintenance by the combined administration of vasopressin and epinephrine in brain death: a clinical study . Neurosurgery. 1986;;18:565-567.
58 +
Davis S, Olichwier KK, Chakko SC.  Reversible depression of myocardial performance in hypophosphatemia . Am J Med Sci. 1988;;295:183-187.
59 +
Baldwin TE, Chernow B.  Hypocalcemia in the ICU: coping with the causes and consequences . J Crit Ill. 1987;;2:9-16.
60 +
Kroncke GM, Nichols RD, Mendenhall JT, Meyerowitz PD, Starling JR.  Ectothermic philosophy of acid-base balance to prevent fibrillation during hypothermia . Arch Surg. 1986;;121:303-304.
61 +
Swain JA.  Hypothermia and blood pH: a review . Arch Intern Med. 1988;;148:1643-1646.
62 +
White FN.  A comparative physiological approach to hypothermia . J Thorac Cardiovasc Surg. 1981;;82:821-831.
63 +
Jarnberg P-O, DeVillota DE, Eklund J, Granberg P-O.  Effects of positive end-expiratory pressure on renal function . Acta Anaesthesiol Scand. 1978;;22:508-514.
64 +
Matuschak GM, Pinsky MR, Rogers RM.  Effects of positive end-expiratory pressure on hepatic blood flow and performance . J Appl Physiol. 1987;;62:1377-1383.
65 +
Curley FJ, Irwin RS.  Disorders of temperature control: hypothermia, part III . J Intensive Care Med. 1986;;1:270-288.
66 +
Kaufman HH, Hui KS, Mattson JC, et al.  Clinicopathologic correlations of disseminated intravascular coagulation in patients with severe head injury . Neurosurgery. 1984;;15:34-42.
67 +
Gifford RRM, Weaver AS, Burg JE, Romano PJ, Demers LM, Pennock JL.  Thyroid hormone levels in heart and kidney cadaver donors . J Heart Transplant. 1986;;5:49-253.
68 +
Wahlers T, Fieguth HG, Jurmann M, et al.  Does hormone depletion of organ donors impair myocardial function after cardiac transplantation? Transplant Proc. 1988;;20( (suppl 1) ):792-794.
69 +
Novitzky D, Wicomb WN, Cooper DKC, Tjaalgard MA.  Improved cardiac function following hormonal therapy in brain dead pigs: relevence to organ donation . Cryobiology. 1987;;24:1.
70 +
Wicomb WN, Cooper DKC, Novitzky D.  Impairment of renal slice function following brain death, with reversability of injury by hormonal therapy . Transplantation. 1986;;41:29-33.
71 +
Novitzky D, Cooper DKC, Morrell D, Isaacs S.  Change from aerobic to anerobic metabolism after brain death, and reversal following triodothyronine therapy . Transplantation. 1988;;45:32-36.

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