Table 1:

Summary of recommendations

Cardiovascular performance, monitoring and hemodynamic support

Vasoactive medications

We suggest intravenous vasopressin as a first-line vasoactive agent for hypotension (conditional recommendation, very low-certainty evidence). We suggest intravenous norepinephrine as a second-line agent for hypotension not responding to vasopressin alone (conditional recommendation, very low-certainty evidence). We suggest against the use of dopamine at any dose (conditional recommendation, low-certainty evidence). We make no recommendation regarding other vasoactive medications and inotropes.

Antihypertensive medications

We suggest using short-acting intravenous antihypertensive agents as per standard ICU practice to prevent end-organ damage (conditional recommendation, very low-certainty evidence).

Minimal acceptable blood pressure target

We suggest maintaining mean arterial pressure ≥ 65 mm Hg rather than a lower threshold (conditional recommendation, very low-certainty evidence).

Fluid resuscitation

We suggest infusing crystalloids, rather than colloids, for plasma-volume expansion (conditional recommendation, low-certainty evidence).

Protocolized fluid management

We make no recommendation regarding the use of fluid management protocols.

Glycemic control and nutrition

Glucose control

We suggest maintaining serum glucose levels in the range of 6–10 mmol/L, rather than a lower range of 4–6 mmol/L (conditional recommendation, very low-certainty evidence).

Glucose, insulin and potassium administration

We suggest against the infusion of combined solutions of glucose, insulin and potassium (conditional recommendation, very low-certainty evidence).

Nutritional support

We suggest providing enteral nutrition as compared with no nutritional support (conditional recommendation, very low-certainty evidence).

Diabetes insipidus and hypernatremia

Serum sodium control

We suggest maintaining serum sodium concentration in the normal range (135–155 mmol/L) (conditional recommendation, very low-certainty evidence).

Diabetes insipidus and vasopressin

We suggest treating diabetes insipidus with desmopressin or vasopressin during hemodynamic stability (conditional recommendation, very low-certainty evidence). We suggest treating diabetes insipidus with vasopressin during hemodynamic instability (conditional recommendation, very low-certainty evidence).

Hormonal therapy

Thyroid hormone

We suggest against routine thyroid hormone supplementation (conditional recommendation, low-certainty evidence). We make no recommendation about thyroid hormone supplementation for hemodynamic instability or cardiac dysfunction.

Corticosteroids

We suggest intravenous corticosteroid therapy for donors requiring vasopressor support (conditional recommendation, low-certainty evidence). We make no recommendation about high-dose corticosteroid therapy for potential lung donors.

Transfusion therapy

Transfusion threshold

We suggest withholding red blood cell transfusions unless hemoglobin levels fall below 70 g/L (conditional recommendation, very low certainty in evidence).

Correction of coagulopathy and thrombocytopenia

We suggest that in the absence of clinically significant bleeding, transfusions of fresh frozen plasma be withheld altogether, and that platelet transfusions be withheld unless platelet levels fall below 10 × 109/L (conditional recommendation, very low certainty in evidence).

Bacterial infections

Antibiotics

We suggest reserving antibiotic therapy for the treatment of known or suspected infection (conditional recommendation, very low-certainty evidence).

Routine cultures

We suggest that screening cultures of blood, urine and sputum be performed at intervals consistent with general ICU practice and patient clinical status (conditional recommendation, very low-certainty evidence).

Organ-specific considerations: heart, lungs and intra-abdominal organs

Cardiac assessment tools

We suggest against routine use of pulmonary artery catheters (conditional recommendation, very low-certainty evidence). We suggest serial echocardiography at intervals consistent with general ICU practice (conditional recommendation, very low-certainty evidence).

Cardiac biomarkers

We suggest against the measurement of serum cardiac biomarkers (conditional recommendation, very low-certainty evidence).

Coronary angiography

We suggest against routine coronary angiography (conditional recommendation, very low-certainty evidence). Coronary angiography should be performed in the presence of risk factors for coronary artery disease as determined according to local criteria (good practice statement).

Lung-protective ventilation

We recommend a lung-protective ventilation strategy consisting of low tidal volumes (6–8 mL/kg), high positive end-expiratory pressure (at least 8 cm H20) and recruitment manoeuvres after ventilator disconnections in potential lung donors (strong recommendation, moderatecertainty evidence).

Bronchoscopy

We suggest diagnostic bronchoscopy be performed for potential lung donors (conditional recommendation, low-certainty evidence).

Inhaled β-agonist therapy

We suggest against routine use of inhaled β-agonists (conditional recommendation, moderate-certainty evidence).

Chest radiography and computed tomography scan

We suggest a single routine diagnostic chest radiograph for lung donors and additional chest imaging as clinically indicated (conditional recommendation, low-certainty evidence).

Albumin: creatinine ratio screening

We suggest using the albumin:creatinine ratio for detecting microalbuminuria when assessing potential kidney donors with type 1 or 2 diabetes mellitus (conditional recommendation, very low certainty in evidence).

Hemoglobin HbA1c testing

We suggest that hemoglobin HbA1c testing be performed in potential donors being considered for pancreas donation (conditional recommendation, very low-certainty evidence).

Abdominal imaging

We suggest that abdominal CT or ultrasound should be used only in those with age > 50 yr, comorbid conditions, high body mass index, or clinical history of malignancy (conditional recommendation, low-certainty evidence).

Other therapeutic interventions

Therapeutic hypothermia

We suggest maintaining the core body temperature in the range of 34°C–35°C, unless kidneys will not be used for transplantation, in which case normothermia is appropriate (conditional recommendation, low-certainty evidence).

Duration of donor management

For potential donors with acute organ injury, we make no recommendation regarding timing of organ recovery surgery or optimal duration of ICU donor management (conditional recommendation, very low-certainty evidence).

Note: CT = computed tomography, HbA1c = glycosylated hemoglobin, ICU = intensive care unit.