Ventilatory and hemodynamic management of potential organ donors: An observational survey*

Objective: To determine the current standard ventilatory and cardiovascular management in potential organ donors. Design: Prospective, multiple-center, observational survey. Setting: A total of 15 intensive care units in 13 hospitals in Piedmont, Italy. Patients: A total of 34 brain-dead patients enrolled in 6 months. Measurements and Main Results: Demographics and reasons for lung transplant exclusion were recorded. Ventilatory and hemodynamic variables were compared before and after confirmation of brain death. A total of 23 potential donors were ineligible for lung donation based on pulmonary status and age. Of the 11 eligible lung donors, only two donated the lungs because five had Pao2/Fio2 ratios of <300 and four were ineligible for logistic problems. Tidal volume was 10 ± 2 mL/kg, positive end-expiratory pressure was 3.3 ± 2.7 cm H2O, Fio2 was 50% ± 18% before brain death diagnosis, and no changes were made after brain death confirmation. In potential lung donors, apnea tests were performed with apneic oxygenation after disconnection from the ventilator in all cases; tracheal suction was performed with an open circuit in eight cases, and no recruitment maneuvers were performed. Crystalloid infusion was increased after diagnosis of brain death from 187 ± 151 to 275 ± 158 mL/hr (p < .05), and central venous pressure increased from 6 ± 3 to 7 ± 3 mm Hg (p < .05). Inotropic support was used in 24 donors (70%). Conclusions: Five of 11 potential lung donors (45%) had a Pao2/Fio2 ratio of <300, making them ineligible for lung donation. After the diagnosis of brain death, ventilatory management remained the same, no maneuvers for prevention of derecruitment of the lung were performed, and cardiovascular management was modified to optimize peripheral organ perfusion. These data represent the current standard of care for ventilatory management of potential organ donors and may be suboptimal in preserving lung function. LEARNING OBJECTIVES On completion of this article, the reader should be able to: Explain the issues related to harvesting lungs for transplantation. Describe the management of potential lung donors. Use this information in a clinical setting. All of the authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity. Wolters Kluwer Health has identified and resolved all faculty conflicts of interest regarding this educational activity. Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information on obtaining continuing medical education credit.