Lifesharing Pediatric Donor Management Goals

1.0  PURPOSE

Establish guidelines for the physiologic management and organ placement of pediatric organ donors.

2.0  STATEMENT OF POLICY

2.1  Lifesharing will maximize the number of transplantable organs through the development and implementation of standardized physiologic management guidelines.

2.2  Lifesharing will collaborate with the Pediatric Intensive Care Unit (PICU) medical staff to optimize donor management.

2.3  Donor vital signs, medications, and fluid/blood replacement should be ordered and treated appropriately based on weight and age of the donor.

2.4  Accurate and timely documentation of all donor management requests and activities by Procurement Coordinator.

3.0  DEFINITIONS

N/A

4.0  PROCEDURE

4.1  Hemodynamic Parameters: Blood pressure and heart rate should be maintained to ensure adequate organ perfusion according to the donor’s age. Lowest acceptable Systolic blood pressure= (2 x Age in years) + 70

4.2  Vasoactive Drips:

4.2.1  Minimize vasopressors. Refer to Pediatric Organ Donation Standing Orders for management of hypotension utilizing dopamine, vasopressin, and neosynephrine in sequence of priority.

4.2.2  Prioritize the weaning off of Epinephrine infusions using other fluids and/or medications.

4.2.3  Review plan for initiating/weaning of vasoactive medications with Administrator on call.

4.3  Hormonal Resuscitation Protocol:

4.3.1  Use on all brain dead, potential heart donors to optimize cardiac function.

4.3.2  Use on brain dead, non-heart donors if they are dependent upon large doses of one vasopressor/inotrope or on multiple vasopressors/ inotropes to minimize possible organ dysfunction from use of these drugs.

4.3.3  Refer to Pediatric Organ Donation Standing Orders (ORCL-F006) for initiation and dosing of Levothyroxine/Hormonal Resuscitation Protocol.

4.4  Echocardiogram: Start Hormonal Resuscitation Protocol several hours prior to obtaining echocardiogram so that the echo will reflect a heart that is recovering from the adverse effects of brain death. If possible, wean vasopressors/inotropes to a minimal dose prior to obtaining echocardiogram. If possible, do not obtain an echo if the patient is profoundly hypotensive or tachycardic.

4.5  Urine Output: Urine output should be maintained at a minimum of 1-2 ml/kg/hour. Refer to Pediatric Organ Donor Standing Orders for fluid/blood product replacement and management of diabetes insipidus.

4.6  Temperature: Maintain donor’s body temperature at 35.5-37.5 Celsius utilizing a heating blanket.

4.7  Laboratory Values

4.7.1  All laboratory values should be maintained within the normal range, corrections should be made according to policy Pediatric Organ Donor Standing Orders.

4.7.2  Appropriate laboratory tests should be performed at least every four hours and prn to prevent electrolyte imbalances common with brain-death. Cardiac enzymes need only be done for potential heart donors.

4.7.3  The frequency and amount of additional laboratory tests performed is based on the individual donor and situation, (minimum every four hours)

4.8  Pulmonary: Optimize cardiopulmonary function. Refer to Pediatric Organ Donor Standing Orders for specific evaluation and treatment guidelines of potential lung and heart donors.

4.8.1  Maintain a PO2 >100 mm Hg with the lowest FIO2.

4.9  Antimicrobial Therapy

4.9.1  One hour prior to the operating room (OR), all donors will receive Ancef 25 mm/kg as prophylaxis against possible infection.

4.9.2  Ceftriaxone 75mg/kg/day (not to exceed 2 gm/day) if aspiration is known or strongly suspected.

4.9.3  Continue previously ordered antibiotics, if donor is already being treated for specific infectious process.

4.9.4  Consult with AOC to determine whether Ancef/Rocephin should be discontinued if patient already receiving previous antimicrobial therapy.

5.0  REFERENCES

5.1  Pediatric Organ Donation Standing Orders (ORCL-F006)

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