Table 3.

Post-Brain Death Organ Preservation Protocol

1. Continue with the non-pharmacological support as per comfort care orders

2. Remove all drugs, except antibiotics and those required to maintain hemodynamics, homeostasis and fluid balance

3. If on cardiac assist devices or cardiac pacers, keep them on until consent discussion

4. 0.9% saline IV at 1 ml/kg/hour to maintain euvolemia

5. Ventilation: IPPV, TV 10 ml/kg, PEEP 5 mm Hg, keep plateau pressures – 20 mm Hg

6. Manual lung hyperinflation therapy, immediately after declaration of death

7. Methylprednisolone 15 mg/kg IV bolus

8. T3 @ 4gm IV bolus, then 3 gm/hou IV infusion

9. Vasopressin 1 unit IV bolus, then 0.5-3.0 units/hour to maintain urinary output of 200 ml/hour

10. Paralytics (vecuronium 0.5 mg/k IV slow bolus)

Maintain physiology (homeostasis) close to normal:

11. Central venous pressure 6-12 mm Hg

12. Systolic blood pressure of 90-140 (or MAP 60-80) mm Hg

13. Heart rate (60-120 bpm)

14. Core temperature (34-37.5°C)

15. Urine output 0.5-1.0 ml/kg/hour and under 200 ml/hour

16. Oxygen saturation – 92%

17. Normocarbia (pCO2 40 mmHg)

18. Arterial pH 7.35-7.45

19. Haematocrit 30%

20. Platelets 50,000/cmm

21. Glycemic control (at 80-200 mg/dL), IV insulin protocol as needed

22. Sodium 130-150 mEq/L

23. Potassium 3.5-5.0 mEq/L

24. Magnesium 1.8-4.5 mEq/L

25. Phosphorus 2.0-4.5 mEq/L