dopamine. If these more potent alpha receptor vasopressors are necessary, they should be used with dopamine at renal doses (3-5 ^g/kg/min) to mitigate against splanchnic and renal vasoconstriction.

Usually when urine output is low, volume expansion results in increased urine output. However, diuretics, such as furosemide and mannitol which generally should be avoided in organ donors, can be used to increase urine output as long as there is adequate blood pressure and volume expansion (CVP 12). Many times, however, the problem in brain-dead donors is massive urine output caused by the development of diabetes insipidus due to the lack of the antidiuretic hormone, vasopressin. If urine output exceeds 500 mL/hr, a hypotonic diuresis ensues that should be replaced with hypotonic infusions. If polyuria persists despite adequate fluid replacement, vasopressin may be given at a rate of 0.5-2.0 units per hour to slow diuresis to a more manageable level.

Due to the significant hormonal imbalances seen in brain-dead donors, hormonal management may help to stabilize donors. There has been some evidence that administration of intravenous triiodothyronine (T3) and arginine vasopressin (AVP) may stabilize the brain-dead donor by restoring some of the hormonal imbalances and circulatory instability. Likewise, brain death may cause varying degrees of cortisol depression and steroid replacement therapy with hydrocortisone may be indicated. Additionally, due to the loss of thermoregulatory function with brain death, many organ donors will become hypothermic unless measures are taken to avoid hypothermia and its sequelae. Hypothermia may lead to cardiac arrhythmias, myocardial depression and hypotension leading to poor tissue and organ perfusion. Organ function may also be compromised from decreased oxygen delivery caused by hypothermia. Infusion of warm fluids and external heating devices will help reduce hypothermia and its adverse effects. Another common problem in brain-dead donors is the presence of coagulopathy caused by tissue thromboplastin release. Coagulopathy, although difficult at times to manage, can be treated with administration of packed red blood cells, fresh frozen plasma, and platelets.

Since many OPOs have recently instituted DCD programs, it is important to mention some important differences in donor management. DCD donors are not brain dead due to preservation of brainstem reflexes, but usually have severe neurologic injury from which they will not recover. The decision to withdraw support has been made by the primary physician and family before notification of the OPO. These donors tend to be hemodynamically more stable with fewer vaso-pressor requirements than brain-dead donors. The withdrawal of support may occur either in the intensive care unit (ICU) setting, where the patient expires and is conveyed to the operating room, or alternatively in the operating room. In either instance, the patient must be pronounced dead by a physician not affiliated with the transplant team. The patients should be fully supported until withdrawal of support is initiated. The administration of vasodilators and anticoagulants at the time of support withdrawal may be given on a case-by-case basis in accordance with IOM guidelines. Likewise, an additional period of 5 minutes must

Diabetes Sustenance

Diabetes Sustenance

Get All The Support And Guidance You Need To Be A Success At Dealing With Diabetes The Healthy Way. This Book Is One Of The Most Valuable Resources In The World When It Comes To Learning How Nutritional Supplements Can Control Sugar Levels.

Get My Free Ebook

Post a comment