Management of the Brain Dead Potential Donor

Airway
Breathing
Circulation
Exposure
How else can you help Organ Donation in South Africa?

The best place for the organs while all logistics are being sorted out is within a well functioning body. Transplant coordinators are trained ICU sisters and always available to discuss donor management. In the Western Cape, once consent is obtained for donation, management of the donor becomes the responsibility of the transplant team. The transplant coordinator is an ICU trained nurse & will manage the patient up until the donor operation. This helps minimise the disruption to clinical services & not divert staff away from their existing clinical duties.

Airway

• Keep intubated 

Breathing

• Keep fully ventilated to maintain a saturation of > 90% (Pa02> 10 kPa). 

Circulation

• BP maintained with a systolic > 90mmHg in adults. 
• Two reliable IV lines are required (preferably one central line) as fluid resuscitation is often ongoing. 
• If inotropes are required - dopamine infusion at 3-5 µg/kg/min titrated to the BP can be used. 
• Urine output - targeted at 100ml/hr. 
  • Donors may become polyuric (secondary to the brain injury & ADH secretion) & require large volumes of fluid to replace urine output (can even be > 1 litre per hour). Check arterial blood gases, serum electrolytes, urea, creatinine & glucose regularly & correct when necessary.
  • If persistently polyuric consider DDAVP

Exposure

• Body temperature maintained > 35°C. A bair-hugger may be required. 

How else can you help Organ Donation in South Africa?

• Take every opportunity to discuss & educate fellow professionals & the public correctly about organ donation. 
• Register with the organ donor foundation (www.odf.org.za) as an organ donor & inform family & friends of your decision. 
• Stay alert to any opportunity for organ donation & always consult rather than not. The effort is always appreciated. 
• The average number of life years gained from an organ donor is 30 - 50 years