Identification and early management of potential donors has become part of the practice of emergency medicine. The establishment of brain death is generally not done in the emergency department (ED); however several steps need to be taken to maximize organ retrieval in appropriate patients. Most organ procurement organizations (OPOs) work closely with their local EDs, providing education in the various facets of organ procurement. Early communication with the OPO is encouraged, as it can help to identify factors that may qualify or disqualify a potential donor, provide assistance in speaking with families about organ donation, and guide the clinicians through the entire complicated process.
Initial management is centered around maintaining the integrity of potential donor lungs by optimizing hemodynamics and preventing aspiration. Accepting centers generally require a clear chest radiograph, PaO2>450 mmHg on 100% Fío2, and no obvious infection on bronchoscopic evaluation. Mechanical ventilation should maintain arterial Po2>80 mmHg, Pco2 between 35 and 45 mmHg, and a pH between 7.30 and 7.45. Hemodynamics should be monitored, with a desirable central venous pressure >10 mmHg. If systemic blood pressure cannot be maintained with fluid resuscitation alone without causing pulmonary edema, then dopamine may be used. Transfusions may be used to maintain a hematocrit >30% to optimize tissue oxygenation. However, it is crucial to specify the use of blood that is cytomegalovirus (CMV)-negative blood so as not to infect a CMV-negative recipient.
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