Donor Resuscitation And Stabilization

Clearly, proficient management of the organ donor before retrieval is of paramount importance. However, what may be equally important is the expeditious removal of organs when a donor's condition is difficult to stabilize. In these instances, the organs should be removed as quickly as possible to avoid the risk of the donor having a cardiac arrest or suffering long periods of hypotension.

The hemodynamic management of the donor is of primary importance and includes maintaining an adequate blood pressure (> 100 mmHg) and urine output (> 100 mL/hr). Once the donor has been declared brain dead, large volumes of fluid and plasma expanders may be necessary to resuscitate the donor to achieve adequate blood pressure and urine output. Hemodynamic monitoring with a central venous catheter (CVP), arterial line, and sometimes a pulmonary artery catheter are usually necessary. Care should be exercised to avoid over-hydration which may cause over-distension of the heart as well as congestion of the lungs and liver which may later affect the function of these organs. Because of the hemodynamic instability caused by severe brain injury due to catecholamine hyperactivity which is followed by hypoactivity, volume alone may not stabilize the donor. Vasopressor support, usually with dopamine, is adequate to stabilize the donor. High-dose dopamine in doses up to 15 ^g/kg/min has been shown to be well tolerated. Although vasopressors, such as levarterenol and phenylephrine, should be avoided since they have a greater propensity to cause organ ischemia, they may be necessary to maintain an adequate blood pressure. However, attempts should be made to reduce the dosages by volume resuscitation and the use of

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