Donor Management Guidelines
Hemodynamics and Blood Pressure Control
Consult with Intensivist ASAP after authorization to determine plan of care; ensure
they are updated throughout case and that all orders are run through them.
Donor Management Goals: (Goal is meet them within 12 hours of authorization)
MAP > 60
CI > 2.5
UO 0.5-3cc/kg/hr
pH 7.30-7.45
P/F Ratio > 350 (if donor >/=60 yo should be > 300)
Place Flotrac on all donors ASAP (donors <12 years old are excluded)
Obtain cardiac parameters every hour (CO/CI/SVV)
Initiate T4: Give 20mcg bolus over 3 minutes followed by continuous gtt @ 10mcg/hr
Solumedrol 500mg IVP
Narcan 8mg IVP
Norcuron 10mg IVP (give prior to narcan)
Volume status:
Hypovolemia 1) Start with crystalloids: (NS is fluid of choice)
2) Assess pt’s I&O for last couple of days ASAP
 Pay close attention to cardiac parameters, lung sounds and PCXR during
rehydration
Hypotension: Make sure you have the T4 going ASAP
1. Volume
2. The following pressors/doses may be used if needed
Dopamine 3-10mcg/kg/min
Epinephrine 0.05-0.5mcg/kg/min
Norepinephrine 0.1-2mcg/kg/min
Neosynephrine 0.1-1mcg/kg/min
Hypertension:
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Consult with intensivist for MAP >120
Management of Heart Rate and Rhythm
Symptomatic Bradycardia (hypotension or decreased cardiac/urine output:
Notify intensivist ASAP
Look for underlying cause!!
- acidosis
- electrolyte imbalance
- cardiac contusion
- hypothermia
- handling of the heart
 Immediate intervention--Isuprel gtt or cardiac pacing
 Isuprel-1mg/250cc D5W Start @ 2-10mcgs/min and titrate
 Pacing-external, or if available can do transvenous if placed by a cardiologist
 If continues to be unstable proceed to the OR!!
Symptomatic Tachycardia:
Notify intensivist ASAP
Look for underlying cause and treat!!
- Hypovolemia
- Hyperthermia
- Infection
- Vasopressin infusion (if caused by this, it is usually evidenced within 30”
of start of infusion and takes 2-3hrs to stop)
- Dopamine or Epinephrine infusion
-Consider discontinuing T4 (after consultation with intensivist)
V-Tach/V-Fib
Initiate ACLS
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Cardiac Catheterization Management
Consult with intensivist and consider pre-treatment if creat > 1.2
2amps Bicarb/1liter sterile water, run at 300/hr for 1 hr then at 100/hr until liter finished
600mg Mucomyst via NG q 12hrs x2 doses
Instruct cardiologist to use no more than 60-70 cc of contrast
Make sure cardiologist knows that we do not need an LV gram, only coronaries
***Make sure the pt is adequately resuscitated before going to CVL***
IV Orders
Maintenance IV: D5 1/2NS
U.O. Replacement: 1/2NS
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Urine Output
Polyuria: (Normal 0.5-3cc/kg/hr)
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Usually is caused by diabetes insipidus which results from the insufficiency of ADH from
the posterior pituitary and is evidenced by rising Na and UO > 3cc/kg/hr.
1. Vasopressin (aqueous) IV drip use 1:1 concentration 1-2.5u/hr
2. DDAVP (desmopressin) 0.5-2.0mcg IVP over 10” (This may be repeated q2-3hrs)
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Hyperosmolar diuresis can be caused by elevated glucose, check glucose level and treat
appropriately
Oliguria/Anuria:
 Check patient’s volume status (use the Flotrac and I&O to guide you) REHYDRATE!
If oliguria does not resolve with rehydration consult with intensivist for diuretic management.
Blood Glucose Management
Monitor accuchecks every 1-2hrs, if sugars unstable do every 1hr
Insulin infusion to keep BS between 80 - 200
Electrolytes
Potassium:
<2.5 consult with intensivist
2.5-2.9 = 40meq via NG
3.0-3.5 = 30meq via NG
3.5-5.0 = Monitor
If > 5.0 = consult with intensivist
**You are much safer with a low potassium that a high one
** If giving lots of insulin your K+ will decrease,remember it is there, just hiding—get your
sugars down**
Phosphorus/Magnesium:
Standards: Phos 3-4.5
Mag 1.7-2.3
Treatment(s):
Bolus of Mg and Phos: 2gms MgSO4/100cc NS TRO 2 hours
Kphos or NaPhos 30mmols/100cc NS TRO 2 hours
If above Mg and PO4 are just slightly decreased then the above doses may be
placed in the maintenance fluid. Use NaPhos if the K+ is elevated
Use Kphos if NA elevated
Calcium: monitor Ionized Calcium and replace with CaCl after consultation with intensivist
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Thermoregulation
Standard: 97-99O F or 36-37.5O C
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Hypothermia: wrap head, warm fluids, warming blanket, increase room temp
Hyperthermia: infection should be considered
Contact intensivist for further orders
Hematology and Coagulopathy Parameters
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Maintain Hgb 8.0-10.0; Consider transfusion if <8.0 and after consultation with the
intensivist
**use leuko-reduced blood if possible**
 Labs:
 PT: normal 11.5-15.0
PTT: normal 28-38
Fibrinogen: normal 100%
Platelets: normal >50
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If patient displays signs of frank bleeding, order PT/INR/PTT/Fibrinogen/Platelet count
and call the intensivist for treatment.
After all treatment, repeat CBC and coagulation tests
Pulmonary Management
Ventilation: Utilize Intensivist on call to determine appropriate ventilator settings
Obtain ABGs on current ventilator settings and contact intensivist for further orders; consider
the following:
Ventilator settings:
Mode: Pressure Regulated Volume Control (PRVC)
Rate: Set initial rate to 12
PEEP: 8.0
FiO2: 1.0
TV: Target to 8ml/kg ideal body weight based on height to keep plateau pressure < 30cm/H2O
If plateau pressure > 30 cmH2O, decrease TV in 1ml/kg IBW (no lower than 6ml/kg) and increase
respiratory rate to maintain the same minute volume.
ABGs 30min after above settings initiated.
Target pH between 7.30 and 7.45
Ongoing management:
Wean FiO2 to keep SpO2 > 93% and do not go below 40%
Once TV determined, titrate respiratory rate to maintain pH within target range
Lung recruitment maneuver q 2-4hrs after patient properly resuscitated: CPAP of 40cmH2O for 40 seconds
For wheezing or signs of reactive airways give 8puffs Combivent MDI q 4hrs PRN
ABGs a minimum of q 4hrs
Consider prone positioning if refractory hypoxemia persists
Contact Intensivist for:
 Persistent acidemia with minute ventilation > 15 and/or pH <7.30
 Persistent hypoxemia, PaO2 < 75mmHg or SpO2 <93 on more than .60 FiO2 and/or more than
12cm PEEP
 Ventilator changes not included on the order sheet
 Total respiratory rate >30 bpm
 Does not tolerate lung recruitment manuever
Lung Placement
 O2 challenge: After patient stable on above ventilator settings
Increase FiO2 to 100% get ABG after 10 minutes
If PO2 > 300 and there are no absolute contraindications for lung placement
make lung offers
 Sputum gram stain
 Lung measurements, chest circum. @ nipple line during full expansion
 CXR
Have O2 challenge and CXR current w/in 2 hours of lung offers
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