Table 9.

Donor Physiologic Responses after Neurologic Determination of Death, Management Goals, and Recommended Intervention by Organ System^93–97

System	Physiologic Responses	Management Goals	Recommended Intervention
Cardiovascular	• Initial hypertensive crisis followed by hypotension	• MAP ≥60 mm Hg	• Nitroprusside or esmolol for initial hypertension
		• CVP 4–10 mm Hg	• Vasoactive agents to maintain hemodynamic goal and organ perfusion: dopamine, vasopressin (refractory shock), norepinephrine, phenylephrine, dobutamine, epinephrine (severe shock)
	• Arrhythmia secondary to metabolic derangements	• HR 60–120 beats/min
		• Left ventricular ejection fracture ≥45%
		• ≤1 vasopressor and low dose (eg, dopamine ≤10 µg/kg/min)
Respiratory	• Pulmonary edema	• Pao2/Fio2 ratio >300 mm Hg	• Use lung-protective ventilation (eg, small TV 6–8 mL/kg, low Fio2, high PEEP 8–10 cm H2O)
		• pH value from arterial blood gas 7.3–7.45
			• Begin with lung recruitment maneuvers
			• Elevate head of bed to reduce risk of aspiration
			• Consider diuretics if marked fluid overload
Renal	• Vascular constriction resulting in AKI	• Urine output over 4 h	• Goal is euvolemia using CVP, PAOP, or PPV and SVV with preferably crystalloid
		≥ 1 mL/kg/h
Endocrine	• Hyperglycemia	• Glucose level <150 mg/dL*	• Insulin infusion to goal glucose
	• Vasopressin deficiency		• Consider vasopressin replacement
	• Corticosteroid deficiency		• High-dose corticosteroids bolus then continuous infusion†
	• Hypothyroidism
			• Consider thyroid replacement therapy with T3 and T4 bolus then continuous infusion
Hematologic	• Coagulopathy	• Hemoglobin level >7 g/dL	• Monitor with coagulation laboratory values and TEG
			• Transfuse for hemoglobin <7 g/dL
			• Correct coagulopathy with clotting factors (ie, FFP) or platelets if ongoing bleeding
Neurologic	• Hypothermia	• Temperature >35°C	• Active warming to maintain temperature
	• Central diabetes insipidus and hypernatremia	• Serum sodium level	• Cautious correction of hypernatremia can be possible with slow, hypotonic infusion of 0.45% NaCl
		<155 mmol/L
	• Movements mediated by spinal reflexes		• Intraoperative skeletal muscle paralysis to reduce somatic response to surgical stimulus

^*Hyperglycemia should be controlled based on institutional intensive care unit guidelines.

^†High-dose corticosteroids should only be administered after blood has been collected for tissue typing.

AKI, acute kidney injury; CVP, central venous pressure; FFP, fresh frozen plasma; Fio₂, fraction of inspired oxygen; HR, heart rate; NaCl, sodium chloride; Pao₂, partial pressure of arterial oxygen; PAOP, pulmonary artery occlusion pressure; PEEP, positive end-expiratory pressure; PPV, pulse pressure variation; SVV, stroke volume variation; T3, triiodothyronine; T4, thyroxine; TEG, thromboelastogram; TV, tidal volume.