Care of the patient prior to Organ Donation

Patients with potential for organ donation need to maintain organ viability in response to potentially severe autonomic and inflammatory responses that occur after severe neurologic insult or brain death.

Interventions often require a delicate balance to preserve multiple organs:

 • Continuous temperature monitoring, telemetry, and lab monitoring for renal function, electrolytes, acid-base status

 • Hemodynamics – goal MAP 60-110

    - Hypertensive autonomic storm after brain death. Esmolol to preserve cardiac function.

    - Fluids and vasopressors for hypotension/vasoplegia. Consider vasopressin before catecholamines (helps w/ DI)

    - Dobutamine for reduced EF

 • Maintenance of normothermia via external warming or cooling

 • Urine output monitoring – goal 0.5-1.0 cc/kg/hr. Monitor for DI with severe neurologic injury or brain death.

 • Proper ventilatory support and pulmonary toilet – lung-protective LTVV as in ARDSNet. Prevent pneumonia with head

elevation, etc. 

 • Maintenance of eunatremia, euvolemia, and acid-base status

 • Consider glucocorticoids for adrenal insufficiency; thyroid hormone for EF <45% or hemodynamic instability (limited evidence)

 • Empiric antibiotics if concern for infection



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