Optimizing Organ Donation After Euthanasia: A Critical Appraisal
Abstract
:1. Introduction
Different Countries and Different Protocols for Carrying out Euthanasia
2. Materials and Methods
Research Strategy
3. Results
- Van Reeven M et al.
- 2.
- Gilbo et al.
- 3.
- Lighthall GK et al.
- 4.
- Sauer M et al.
- 5.
- Dundee J.W.
- 6.
- Shingu et al.
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
ODE | organ donation after euthanasia |
nNMBs | non-depolarizing neuromuscular blocking agent |
DCD-III | donation after circulatory death with withdrawal of life support |
LT | liver transplantation |
DCD-V | donation after circulatory death because of euthanasia |
DFWIT | donor first warm ischemia time |
LDH | lactate dehydrogenase |
Appendix A
- Midazolam 5–15 mg (optional).
- Lidocaine 1% 2 mL in 30 s.
- Thiopental 2000 mg or propofol 1000 mg, maximum of 5 min.
- Rocuronium 150 mg, atracurium 100 mg, or cisatracurium 30 mg.
- Midazolam 5–15 mg (this is optional and only given to restless patients).
- Thiopental 2000 mg of Propofol 1000 mg.
- Atracurium 100 mg, Cisatracurium 20 mg, Mivacurium 20 mg, or Rocuronium 100 mg.
- Midazolam 10–20 mg.
- Lidocaine 1% 40 mg.
- Propofol 1000 mg.
- Rocuronium 200 mg.
- Midazolam 5–20 mg.
- Lidocaïne 1% 40 mg.
- Propofol 1000 mg or Thiopental 2000 mg.
- Atracurium 100 mg, Cisatracurium 30 mg, or Rocuronium 150 mg.
Appendix B
- Research strategy
Concept | PICO |
Population | Patients who are eligible for organ donation |
Intervention | Administration of euthanasia medication |
Comparison | Different countries that permit organ donation (Netherlands, Belgium, Spain, and Canada) |
Outcome | Variance in the quality of abdominal organs |
- 2.
- PubMed search
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The Netherlands [5] | Belgium [8] | Canada [9] | Spain [10] | |
---|---|---|---|---|
Benzodiazepine | Midazolam 5–15 mg (optional) | Midazolam 5–15 mg (optional) | Midazolam 10–20 mg | Midazolam 5–20 mg |
Local anesthetics | Lidocaine 1% 20 mg | Not used | Lidocaine 1% 40 mg | Lidocaine 1% 40 mg |
Coma-inducer | Thiopental 2000 mg or Propofol 1000 mg (almost never used) | Thiopental 2000 mg (54%) or Propofol 1000 mg (45%) | Propofol 1000 mg | Propofol 1000 mg (100%) or Thiopental 2000 mg (0%) |
Neuromuscular blocking agents (nNMBA) | Rocuronium 150 mg or Atracurium 100 mg or Cisatracurium 30 mg | Atracurium 100 mg or Cisatracurium 20 mg or Mivacurium 20 mg or Rocuronium 100 mg | Rocuronium 200 mg Cisatracurium 40 mg | Atracurium 100 mg or Cisatracurium 30 mg or Rocuronium 150 mg |
Medication | Euthanasia [5] | Recommended Dose for Induction of General Anesthesia [11] | Side Effects [11,12] |
---|---|---|---|
Thiopental | 2000 mg | 560–1120 mg | Arterial spasm, thrombosis, hypotension |
Propofol | 1000 mg | 175.0 mg | Hypotension, toxic pancreatitis, acute kidney injury, propofol infusion syndrome |
Rocuronium | 150 mg | 42 mg | Hypotension |
Atracurium | 100 mg | 21.0–42.0 mg | Histamine reaction, hypotension |
Cisatracurium | 30 mg | 12.6 mg | Histamine reaction, hypotension |
Mivacurium | 20 mg | 4.9–17.5 mg | Histamine reaction, hypotension |
Study | Population | Intervention | Outcome | Results |
---|---|---|---|---|
Van Reeven M et al. Evaluation of Liver Graft Donation After Euthanasia. JAMA Surg, 2020 [22]. | 2 cohorts: DCD-III: 542 liver grafts DCD-V: 47 liver grafts | The function of liver grafts in DCD-III vs. DCD-V donors. | Primary outcomes: patient and graft survival at years 1, 3, and 5. Secondary outcomes are postoperative complications. | No statistical differences between DCD-III and DCD-V in graft and patient survival. The postoperative complications were the same. |
Gilbo et al. Survival of Patients With Liver Transplants Donated After Euthanasia, Circulatory Death, or Brain Death at a Single Center in Belgium. JAMA 2019 [18]. | 3 cohorts: DCD-III: 48 liver grafts DCD-V: 8 liver grafts DBD: 519 liver grafts | The function of liver grafts in DCD-III, DCD-V, and DBD donors. | The primary outcome was patient survival at one year post-transplantation. | No statistical differences between DCD-III, DCD-V, and DBD in graft and patient survival. |
Lighthall GK et al. A comparison of the onset and clinical duration of high doses of cisatracurium and rocuronium. J Clin Anesth 1999 [25]. | 4 cohorts: Cisatracurium 0.15 mg/kg (n = 10) Cisatracurium 0.2 mg/kg (n = 10) Rocuronium 0.9 mg/kg (n = 10) Rocuronium 1.2 mg/kg (n = 10) | Patients undergoing anesthesia receiving either cisatracurium or rocuronium. | Rocuronium had a quicker onset than cisatracurium at equivalent doses, and recovery tended to be faster for cisatracurium. However, this was not statistically significant. | The data indicate a tendency for cisatracurium to lead to faster clinical recovery compared to equivalent doses of rocuronium. |
Sauer M et al. Rocuronium is more hepatotoxic than succinylcholine in vitro. Eur J Anesthesiology 2017 [26]. | Human liver cell line HepG2/C3A in vitro | Toxicity of different concentrations of rocuronium and succinylcholine. | Rocuronium demonstrated a reduction in cell viability and cytochrome 1A2 activity, in a dose-dependent pattern. | For all tested parameters, rocuronium was scored as being more hepatotoxic than succinylcholine. |
Dundee J.W. Thiopentone as a factor in the production of liver dysfunction. Br J Anaesth 1955 [27]. | 464 patients, divided into two cohorts of 232 each | Administration of thiopentone as the main anesthetic or only for induction of anesthesia. | Liver dysfunction, measured by the excretion of urobilinogen in urine 3 days postoperation. | High doses of thiopentone (>750 mg) significantly increase liver dysfunction. Using thiopentone only for induction reduces this risk. |
Shingu et al. Effect of Oxygen Concentration, Hyperthermia, and Choice of Vendor on Anesthetic-Induced Hepatic Injury in Rat. 1983 [28]. | Male Sprague-Dawley rats (approx. 300 g), from Zivic-Miller and Charles River | Phenobarbital pre-treatment, 2 h of hypoxia with anesthetics (halothane, enflurane, isoflurane, thiopental, fentanyl). | Hepatic injury (centrilobular necrosis), effects of hypoxia, hyperthermia, hypothermia, and vendor differences. | Thiopental caused significant hepatic injury at 10% oxygen, not at 20% or 100% oxygen. Hypothermia did not protect. Differences noted between vendors. |
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Alkemade, E.A.J.; Lam, H.D.; Hendriks, B.J.C.; Braat, A.E.; Alwayn, I.P.J.; Coenraad, M.J.; Baranski, A.G. Optimizing Organ Donation After Euthanasia: A Critical Appraisal. Transplantology 2025, 6, 10. https://doi.org/10.3390/transplantology6020010
Alkemade EAJ, Lam HD, Hendriks BJC, Braat AE, Alwayn IPJ, Coenraad MJ, Baranski AG. Optimizing Organ Donation After Euthanasia: A Critical Appraisal. Transplantology. 2025; 6(2):10. https://doi.org/10.3390/transplantology6020010
Chicago/Turabian StyleAlkemade, E. A. J., H. D. Lam, B. J. C. Hendriks, A. E. Braat, I. P. J. Alwayn, M. J. Coenraad, and A. G. Baranski. 2025. "Optimizing Organ Donation After Euthanasia: A Critical Appraisal" Transplantology 6, no. 2: 10. https://doi.org/10.3390/transplantology6020010
APA StyleAlkemade, E. A. J., Lam, H. D., Hendriks, B. J. C., Braat, A. E., Alwayn, I. P. J., Coenraad, M. J., & Baranski, A. G. (2025). Optimizing Organ Donation After Euthanasia: A Critical Appraisal. Transplantology, 6(2), 10. https://doi.org/10.3390/transplantology6020010