Anesthetic management of organ donation after brain death using continuous total hemoglobin measurement

A 60-year-old woman declared brain dead was scheduled for organ donation. We continuously measured total hemoglobin values (SpHb) using a Radical-7™ monitor (Masimo Co, Irvine, CA, USA) to maintain the functions of organs and oxygen delivery. At the start of surgery, the SpHb value was 9.3 g·dl^-1. Racked red blood cells were transfused immediately. No anesthetics or opioids were used during the operation. Blood pressure suddenly decreased to below 80 mmHg because of bleeding, manipulation of organs, and/or compression of the vena cava. Six units of red blood cells and 900 ml of colloids were rapidly transfused with real-time monitoring of SpHb values. On cross-clamping of the aorta, the SpHb value increased up to 10.2 g·dl^-1. The heart, lungs, liver, pancreas, and kidneys were donated from the patient without organ dysfunction. The highlight of this case report is that anesthesiologists could use SpHb monitoring for management of hemodynamics in a brain-dead organ donor.