U.S. Department of Health and Human Services
Advisory Committee on Organ Transplantation
Recommendations to the Secretary

Critical Pathway for the Organ Donor (appendix 3)
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Collaborative Practice
The following professionals may be involved to enhance the donation process.
Check all that apply.
o Physician
o Critical care RN
o Organ Procure-ment Organiza-tion (OPO)
o OPO Coordinator (OPC)
o MedicalExaminer (ME)/Coroner
o Respiratory
o Laboratory
o Radiology
o Anesthesiology
o OR/Surgery staff
o Clergy
o Social worker

Phase I: Referral
Collaborative Practice
o Notify physician regarding OPO referral
o Contact OPO ref: Potential donor with severe brain insult
o OPC on site and begins evaluation: Time ___Date ___
o Ht____ Wt ____ as documented
o ABO as documented _____
o Notify house supervisor/charge nurse of presence on unit
Labs/Diagnostics
none
Respiratory
o Pt on ventilator
o Suction q 2 hr
o Reposition q 2 hr
Treatments/Ongoing Care
none
Medications
none
Optimal Outcomes
The potential donor is identified & a referral is made to the OPO.

Phase II: Declaration of Brain Death and Consent
Collaborative Practice
o Brain death documented
Time _____ Date _____
o Pt accepted as potential donor
o MD notifies family of death
o Plan family approach with OPC
o Offer support services to family (clergy, etc)
o OPC/Hospital staff talks to family about donation
o Family accepts donation
o OPC obtains signed consent- & medical/social history
Time _____ Date _____
o ME/Coroner notified
o ME/Coroner releases body for donation
o Family/ME/Coroner denies donation - stop pathway - initiate post-mortem protocol - support family
Lab/Diagnostics
o Review previous lab results
o Review previous hemodynamics
Respiratory
o Prep for apnea testing: set FiO2 @ 100% and anticipate need to decrease rate if PCO2.< 45 mm Hg
Treatments/Ongoing Care
o Use warming/cooling blanket to maintain temperature at 36.5° C - 37.5 °C
o NG to low intermittent suction
Medications
none
Optimal Outcomes
The family is offered the option of donation & their decision is supported.

Phase III: Donor Evaluation
Collaborative Practice
o Obtain pre/post transfusion blood for serology testing (HIV, Hepatitis, VDRL, CMV)
o Obtain lymph nodes and/or blood for tissue typing
o Notify OR & anesthesiology of pending case
o Notify house supervisor of pending donation
o Chest & abdominal circumference
o Lung measurements per CXR by OPC
o Cardiology consult as requested by OPC
o Organ recovery process discontinued - donor organs unsuitable for transplantation
Labs/Diagnostics
o Blood chemistry
o CBC + diff
o UA o C & S
o PT, PTT
o ABO o A Subtype
o Liver function tests
o Blood culture X 2 / 15 minutes to 1 hour apart
o Sputum Gram Stain & C & S
o Type & Cross Match ____# units PRBCs
o CXR o ABGs
o EKG o Echo
o Consider cardiac cath
o Consider bronchoscopy
Respiratory
Continue Phase II
o Maximize ventilator settings to achieve SaO2 98 - 99%
o PEEP = 5cm O2 challenge for lung place-ment FiO2 @ 100%, PEEP @ 5 X 10 min
o ABGs as ordered
o VS q 1
Treatments/Ongoing Care
Continue Phase II
o Check NG placement & output
o Obtain actual Ht _____ & Wt _____ if not previously obtained
Medications
o Medication as requested by OPC
Optimal Outcomes
The donor is evaluated & found to be a suitable candidate for donation.

Phase IV: Donor Management
Collaborative Practice
o OPC writes new orders
o Organ placement
o OPC sets tentative OR time
o Insert arterial line/ CVP/2 large-bore IVs
Lab/Diagnostics
o Determine need for additional lab testing
o CXR after line placement (if done)
o Serum electrolytes
o H & H after PRBC Rx
o PT, PTT
o BUN, serum creatinine after correcting fluid deficit
o Notify OPC for
___ PT >14___ PTT < 28
___ Urine output is
< 1 mL/Kg/hr
___ > 3 mL/Kg/hr
___ Hct < 30 / Hgb < 10
___ Na > 150 mEq/L
Respiratory
Continue Phases II and III
o Notify OPC for
____ BP < 90 systolic
____ HR < 70 or > 120
____ CVP < 4 or > 11
____ PaO2 < 90 or
____ SaO2 < 95%
Treatments/Ongoing Care
Continue Phase II
Medications
Continue Phase III
o Fluid resuscitation - consider crystolloids, colloids, blood
o DC meds except pressors & antibiotics
o Broad-spectrum antibiotic if not previously ordered
o Vasopressor support to maintain BP > 90 mm Hg systolic
o Electrolyte imbalance: consider K, Ca, PO4, Mg replacement
o Hyperglycemia: consider Insulin drip
o Oliguria: consider diuretics
o Diabetes insipidus: consider antidiuretics
o Paralytic as indicated for spinal reflexes
Optimal Outcomes
Optimal organ function is maintained

Phase V: Recovery
Collaborative Practice
o Checklist for OR
o Supplies given to OR
o Prepare patient for transport to OR
o IVs o Pumps
o O2 o Ambu
o Peep valve
o Transport to OR
Date ________
Time ________
o OR nurse reviews consent & brain death documentation & checks patient's ID band
Diagnostics
o Labs drawn in OR as per surgeon or OPC request
o Communicate with pathology: Bx liver and/or kidneys as indicated
Respiratory
Continue Phases II and III
o Portable O2 @ 100% FiO2 for transport to OR
o Ambu bag and PEEP valve
o Move to OR
Treatments/Ongoing Care
Continue Phase II
o Set OR temp as directed by OPC
o Post mortem care at conclusion of case
Medications
Continue Phase III
o DC antidiuretics
o Diuretics as needed
o 350 U heparin/kg or as directed by surgeon
Optimal Outcomes
All potentially suitable, consented organs are recovered for transplant.

The Critical Pathway was developed under contract with the U.S. Department of Health and Human Services, Health Resources and Services Administration, Division of Transplantation.