What are the methods used to optimise the endocrine & metabolic systems of the potential organ donor? Which physiological values should be targeted?

System
Methods for Optimisation
Targets
Endocrine & Metabolic System
  • Correct electrolyte abnormalities:
    • Hypernatremia (associated with poor liver graft function)
    • Hypokalemia
  • Manage Diabetes Insipidus:
    • Maintain Na+ <155 mmol/L with 5% dextrose
    • Maintain urine output about 1 - 2 ml/kg/h with vasopressin 1 U bolus and 0.5 - 4.0 U/h infusion
    • If failure to control diuresis, intermittent desmopressin may be required
  • Commence early hormone replacement
    • Methylprednisolone - diminishes inflammatory response
      • 15 mg/kg to max 1g
      • Improves outcomes in lung transplant
    • No current role for T3:
      • Associated with adverse effects such as arrhythmias
  • Correct hyperglycemia:
    • Insulin infusion to maintain plasma glucose 4-10 mmol/L
    • Start at minimum 1 unit/h and add a glucose containing fluid if required
  • Correct hypothermia aiming temperature 36-37.5°C:
    • Warmed intravenous fluids
    • Warming blankets
    • Heated and humidified inspired gases
  • Stop nephrotoxic drugs
  • Temperature: 36 – 37.5°C
  • Blood glucose: 4.0 – 10.0 mmol/l
  • Urine output: 0.5 – 2.0 ml/kg/hour