Organ Viability Maintenance
The Centers for Medicare and Medicaid Services (CMS) Conditions of Participation require that hospitals maintain organ viability while allowing the organ procurement organization time to determine the patient's suitability to be an organ donor and prior to consent from legal next-of-kin, if the patient is not a registered donor (please see our CMS page for more information).
To assist our hospitals in complying with this rule, we have developed Organ Viability Maintenance guidelines (click here for a printer friendly version).
Vital Signs and Intake and Output:
- Vital Signs and Intake and Output every hour
- Every 15 minutes if unstable and insert arterial line and central venous pressure line
Hypothermia:
- Warming blanket to maintain core body temperature of 36.0 and 37.5 C
- Rectal temperature every hour
Hypotension:
- Start Dopamine infusion and titrate to maintain Systolic Blood Pressure between 85 and 110mmHg (maximum dose 20mcg/kg/min)
- For CVP less than 6, bolus with ¼ or ½ normal saline
- If HCT less than 25%, recommend 1 unit of PRBCs over 1hour (use CMV negative blood only)
- If patient remains hypotensive, initiate Levophed
Respiratory Function:
- CPT and bag and suction every 2 hours
- Turn patient side to side every 2 hours
- Xopenex 1.25mg every 8 hours(may substitute w/Albuterol 2.5mg every 4 hours)
- Atrovent 0.5mg every 4 hours
- ABG every 8 hours and prn; treat any abnormalities
- Tidal Volume at 10-15ml/kg
- +5 Peep on vent settings, FiO2 at lowest setting to maintain pO2>100
- Chest X-ray every 24 hours or prn
Diabetes Insipidus:
- If urine output greater than 500cc/hr or sodium greater than 160, start a Vasopressin drip
- Mix 5units of Vasopressin in 500ccD5W(0.1u/10cc); start infusion at 0.2 u/hr and titrate to maintain UOP>200cc/hr
Laboratory:
- CBC and Complete Metabolic Profile every 12 hours
- Replace low electrolyte levels of Potassium, Phosphorus, Magnesium and Calcium
- Glucose checks every 6 hours and treat elevated levels with sliding scale regular insulin
Maintenance:
- IVF: D5 ¼ or ½ normal saline with 20mEq KCL at 150cc/hr.
- Urine output replacement: ¼ or ½ normal saline to match urine output cc:cc
- Daily weight
