Donantes a corazón parado: Historia de una esperanza

Abstract

In 1992, Pittsburgh University was the first center that formulated an NHBD protocol Later on, the Institute of Medicine (USA) studied, besides the "controled" patients (whom entered the ICU, the ones who can be programmed for withdrawal), the situation of the "uncontroled" donors, that are the ones who have suffered an unexpected heart attack, with previous illness or without, and that have not being reanimated (Tables 1 and 2). In the other hand, in March of 1995, the Maastricht (Holland) meeting established that, in order to secure the "dead donor rule", the procedures for categories 1I and III (uncontrolled by failed reanimation and controlled by heart attack on hold) can only start 10 minutes after the cardiac massage has ceased, also artificial ventilation (Table 3). Finally, the last Spanish Act (Real Decreto Español) of 1999, that regulates the handling and clinical use of human organs, presents noticeable aspects such as the time on hold before initiating the preserving procedures of the organs, procedures just allowed after five minutes since declared dead . This new Act makes it possible to diagnose brain death by using other tests, scientifically more rigorous and objective, such as the measure of blood flow, and establishes a time of no less than five minutes, placing itself in a medium point between the two minutes of Pittsburgh protocol and the ten minutes of Maastricht. But this hold complements itself with a mayor degree of demand as it is proven that it has no way back, because it is an obligation on every case an adequate period of the application of the CPR and the previous reheatings in hipotherm¡a cases (Tables 4 and 5).