Organ Donor Management

• In the brain-dead donor, provide hormonal resuscitation (T3, methylpred, DDAVP/insulin per center) alongside hemodynamic targets.
• Aim for lung-protective ventilation, euvolemia, normothermia, Na⁺ 135–150, glucose 80–180.
• Treat DI (urine >4 mL/kg/h, rising Na) with DDAVP/desmopressin.
• Family-centered communication; coordinate with procurement early.
• Donation after circulatory death (DCD) protocols are increasingly used alongside brain-dead donation.

Management Goals for Organ Donor Patients

• Primary management goals of the organ donor
• NORMALIZE BLOOD PRESSURE AND INTRAVASCULAR VOLUME: volume plus norepinephrine (levophed) first-line, adding dobutamine if needed; skip routine dopamine · hormone replacement therapy — hold SBP >90 / MAP 60–110 (guided by parameters like CO, SVR)
• OPTIMIZE LUNG FUNCTION AND VENTILATOR PARAMETERS: pulmonary toilet · bronchoscopy · oral hygiene · PEEP 5–10 cm H₂O · pCO₂ 40–45 mm Hg · FiO₂ ≤60%
• CORRECT ACID/BASE AND ELECTROLYTE IMBALANCES: target glucose 80–180 mg/dL · frequent serum and urine electrolyte/osmolality checks · DI treated with hypotonic solution and vasopressin
• ESTABLISH NORMOTHERMIA: block passive heat loss · warming blanket, heated ventilator circuit, fluid warmer, warm ICU room