Kang MC, et al. J Korean Med Sci. 2017 Nov;33(2):e10. https://doi.org/10.3346/jkms.2018.33.e10

With improving healthcare services, the demand for organ transplants has been increasing daily worldwide. Deceased organ donors serve as a good alternative option to meet this demand. The first step in this process is identifying potential organ donors. Specifically, brain-dead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. Some transplant centers follow their own treatment protocols, whereas other countries, such as Bangladesh, do not have any protocols for potential organ donor care. In this review, we discuss how to identify brain-dead donors and describe the physiological changes that occur following brain death. We then summarize the management of brain-dead organ donors and, on the basis of a review of the literature, we propose recommendations for a treatment protocol to be developed in the future.

We measured serum concentrations of trace elements and evaluated their clinical significance in relation to treatment outcomes of critically ill patients. A total of 167 participants (105 men and 62 women; average age, 61.4 years; age range, 18–90 years) were enrolled. Arterial blood concentrations of the trace elements zinc, copper, selenium, and manganese were measured every 14 days. At the time of intensive care unit (ICU) admission, serum concentrations of zinc, selenium, copper, and manganese were lower than the normal values in 75.1, 1.8, 37.8, and 2.1% of patients, respectively. Serum trace element concentrations measured on day 14 of ICU stay were higher than those measured at the time of ICU admission for zinc (53.3 → 80.7 μg/L) and copper (87.1 → 102.3 μg/L). Increased serum zinc and copper concentrations during ICU care were associated with a significantly lower mortality compared to decreased concentrations of zinc (15.6 vs. 83.3%, p = 0.003) and copper (5.6 vs. 50.0%, p = 0.013). At the time of ICU admission, low serum levels of zinc and copper were observed. Patients with increased serum concentrations of zinc and copper had significantly lower mortality.