Goals of Donor Management
Donor management will begin when brain death has been declared and authorization or donor designation for organ donation has been obtained. A PNTB Donation Coordinator will be onsite and will work closely with you to begin donor management.
PNTBs donor management goals are fairly similar to goals that are already in place for any critically ill patient and are meant to optimize and maintain organ function. They are as follows:
-MAP 60-100 (IVF first, followed by vasopressor support if needed)
-CVP 4-10 (preventing pulmonary edema and also treating DI)
-EF >50% (on minimal to no vasopressor support, enabling us to evaluate true heart function without artificial support)
-pH 7.3-7.55 (treat acidosis with ventilator changes or bicarbonate administration)
-P:F ratio >300 (CPT, Albuterol, bronchoscopy, recruitment maneuvers)
-Na 135-155 (proper fluid resuscitation)
-PO4 >1.5 (electrolyte replacements)
-Glucose <150 (insulin infusion)
-UOP 0.5-3 ml/kg/hr (treating hypovolemia, rhabdomyolysis, DI)
In addition to these goals, maintaining normovolemia, normothermia, pulmonary toileting, preventing any electrolyte imbalance, preventing aspiration, treating infections, treating coagulopathy, and preventing cardiac arrest are all best practices when caring for a potential organ donor.
**Donor management does not occur in patients who have been determined to be suitable candidates for donation after circulatory death (DCD). In these circumstances a PNTB coordinator will work with the attending physician for appropriate orders to properly evaluate and maintain the patient’s organs.