An article published in The Journal of the Association of Anaesthetists of Great Britain and Ireland, titled Anaesthesia for organ donation in the brainstem dead — why bother? (see HERE) defends the necessity to use anaesthesia for harvesting organs in this kind of donors. The authors affirm, Faced with the knowledge of the persistence of higher brain and spinal function in some – brain death – donors the inability to test the reticular formation directly and the dramatic perioperative haemodynamic changes that occur, sedation and analgesia should be given with muscle relaxation for organ donation.
It is imperative that public confidence is maintained in the transplant programme. The act of organ donation is a final altruistic one, and we should ensure the provision of general anaesthesia at least sufficient to prevent the haemodynamic response to surgery.
Then, to finish explaining the role played by the anesthesiologist in the extraction of organs in this type of donors (brain-dead organ retrieval), we quote the Guidelines for Management of the brain-dead organ donor in the operation theatre by Dr Vijay Vohra and Col Deepak Kumar Sreevastava (see HERE) that also affirm that the use of anaesthesia is mandatory, the Guidelines says It can be argued that these patients being brain dead, are unlikely to have any sensation and hence may not need anaesthesia. However, there are good reasons for giving anaesthetic agents to these cases.” and the guide continuous, The inhalational anaesthetic may have a beneficial effect by causing peripheral vasodilation also some donors show spontaneous or response to the stimulus when the surgery starts. This is also called mass reflex and is a part of the spinal reflex whereby there are tachycardia, hypertension, perspiration and involuntary movements. Lazarus sign which is seen as movements of the arm and hand towards the body can be very disturbing for those involved in organ retrieval and the staff present the operating theatre. It is therefore mandatory to give the following before surgical incision…”
The organ harvesting from brain dead donor is a more frequent practice due to increasing demand for organs. This practice has some ethical issues not yet resolved.