Mantenimiento del donante

Pacientes seleccionados : en muerte cerebral

Objetivos finales :

(1) systolic blood pressure > 100 mm Hg

(2) oxygen saturation > 95%

(3) body temperature > 36°C

(4) urine output >= 2 mL per kg per hour

(5) normal serum sodium

(6) normal serum osmolarity

(7) normal glycemia

(8) maintain fluid balance (avoid over or under hydration)

To maintain systolic blood pressure and urine output:

(1) fluid resuscitation with crystalloid

(2) blood product transfusion if required

(3) vasopressors if hypotensive after fluid administration, using dopamine 5-10 µg per kg per minute.

One complication of brain death is diabetes insipidus, which can result in:

(1) polyuria

(2) dehydration

(3) hypernatremia

(4) hyperosmolarity

(5) hypokalemia

These can be countered by infusion of pitressin and hyponatremic crystalloid to replace urine losses.

Controlled ventilation with PEEP at 5 cm H2O can help maintain blood gases. If the patient develops hypoxemia perform chest radiographs to exclude pneumonia and neurogenic pulmonary edema.

Endocrine replacement may include:

(1) an insulin infusion to correct hyperglycemia

(2) tri-iodothyronine if thyroid hormone levels fall

(3) hydrocortisone if cortisol levels fall


Couetil J-P. Chapter 8: Myocardial and lung specific requirements for preservation. pages 75-81 (page 76). IN: Dubernard J-M, Dawahra M, McMaster P (editors). Organ Preservation& Transplant Surgery. Martin Dunitz. 2003.

Kinkhabwala M, Busuttil RW. Chapter 52: Transplantation and organ procurement. pages 1177-1186 (Table 52-2, page 1179). IN: Mattox KL, Feliciano DV, Moore EE (editors). Trauma. Fourth Edition. McGraw-Hill. 2000.

Lindop MJ. Chapter 16.6.3. Brainstem death and organ donation. 2.1257-2.1260. IN: Warrell DA, Cox TM, et al (editors). Oxford Textbook of Medicine. Fourth Edition. 2003.