Pre-Brain Death Recommendations to Preserve the
Option of Organ Donation
Note: These are PNTB’s guidelines ONLY and are NOT an order set.
I.
II.
Purpose:
To provide recommendations for the care of patients with severe brain injuries when the focus of care may be
shifting from saving the patient’s life to preserving organ function.
Management Goals:
a. Normalize hemodynamic status
i. Optimize fluid balance:
1. Continue maintenance IV fluid infusion
2. Consider fluid bolus (crystalloid or colloid) for hypotension
3. Blood product replacement as indicated by hospital policy
ii. For hypotension unresponsive to fluid bolus:
1. Consider vasopressor support to maintain SBP >90mmHg (7 years-adult), >80mmHg (6 months-2
years), >60 (0-6 months)
2. Preferred drugs for organ preservation:
a. Dopamine 0-20mcg/kg/min
b. Neosynephrine 0-200 mcg/min (adult), 0.1-0.5 mcg/kg/min (pediatrics)
b. Optimize oxygenation/ventilation
i. Maintain oxygen saturation >95%
1. Adjust FiO2 to keep PaO2 >90
2. Use physiologic PEEP (+5cm H 2O)
ii. Normalize pH (7.35-7.45)
1. Normalize pCO2 (~40mmHg)
2. Administer buffers (e.g. sodium bicarbonate)as indicated
iii. Prevent pulmonary edema/pneumonia
1. Pulmonary toilet/suction/reposition q 1-2 hrs
2. Follow daily chest x-rays
c. Treat coagulopathy
i. Maintain normothermia (core temperature 36.5-37.5°C)
ii. Monitor CBC and coagulation panel daily
iii. Blood product/factor replacement as indicated by hospital policy
d. Treat neuro-endocrine disturbances
i. Diabetes insipidus (urine specific gravity <1.005 and sustained polyuria)
1. Consider treatment of hypernatremia (Na>155)
2. Preferred drugs for organ preservation:
a. DDAVP 0.5-1 mcg IV, repeat dose Q2h as indicated
b. Vasopressin continuous IV infusion 0.5-5 U/h (adult), 0.5-1 milli-U/kg/hr (pediatrics)
ii. Impaired glucose tolerance
1. Utilize hospital insulin therapy protocol to treat hyperglycemia
e. Monitor and treat electrolyte abnormalities
i. Monitor electrolytes daily
ii. Utilize hospital electrolyte replacement protocol
f. Treat infection
i. Broad-spectrum antibiotic coverage for clinical indications of infection
All patient care management will be dictated by the hospital physician/care provider unless or until the
patient has legally been declared brain dead AND there is consent for organ donation.
References:
United Network for Organ Sharing (UNOS) Critical Pathway for the Organ Donor
North American Transplant Coordinators’ Organization Pediatric Donor Management and Dosing Guidelines
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