ANESTHESIOLOGISTS IN ORGAN DONATION

In brain-dead patients, brainstem with or without cortical functions, are absent, and theoretically, the patients are unconscious (see Chapter 56 ). However, because their spinal cords are intact and somatic and visceral reflexes remain,^{[1] [62] [144]} special care is required for anesthetic management. Muscle relaxants are necessary to suppress motor activity mediated by spinal reflexes. Vasodilators usually are employed to suppress hypertension and tachycardia by noxious stimuli. However, there is an opinion that sedation and analgesia should be given with muscle relaxation for organ donation, especially in cases of brainstem brain death,^[40] although analgesic and anesthetic agents are theoretically unnecessary. When anesthesiologists face anesthetic management for organ donation, they should consider the conditions of brain-dead patients and observe whether they are really brain dead or not. Van Norman^[145] stressed that anesthesiologists must have specific knowledge about the medical and legal definitions of death, as well as the ethical concepts behind them.