Clinical protocol for management of potential organ donors with brain death

Objective. To develop a comprehensive clinical protocol for management of potential organ donors with brain death, based on modern evidence-based medicine principles and aimed at maximizing the quantity and quality of transplantable organs. Materials and methods. A systematized approach to donor management is presented, including pathophysiological rationale for therapeutic interventions, standardized donor management goals (DMG), algorithms for hemodynamic and respiratory support, protocols for hormone replacement therapy, correction of electrolyte disorders, and prevention of infectious complications. The protocol is based on the "treat and optimize" philosophy, preferring prolonged optimizing treatment (12–15 hours) over accelerated organ procurement. Results. A comprehensive protocol has been developed, including: detailed tables of mandatory invasive access and monitoring; step-by-step hemodynamic support algorithms with clear indications for vasopressor and inotropic therapy; hormone replacement therapy protocol for refractory instability; hypernatremia correction system as a risk factor for liver transplant dysfunction; rational antibiotic prophylaxis schemes; organ-specific management approaches; laboratory monitoring system with specified frequency and critical values of parameters. Conclusion. The presented protocol implements the concept of transformative intensive care medicine, where donor management is considered as high-tech medical care aimed at saving multiple lives. Strict adherence to the DMG protocol with achievement of target parameters (mean BP 60–70 mmHg, urine output 0.5–1.0 ml/kg/h, PaO2 >100 mmHg, temperature >35°C, sodium<155 mmol/L) significantly increases the quantity and quality of transplantable organs.