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Maintaining hemodynamic stability in the pediatric organ donor

Maintaining hemodynamic stability in the pediatric organ donor
Hemodynamically stable Hemodynamically unstable
  • Methylprednisolone
  • Levothyroxine OR triiodothyronine administration should be considered in this patient population
  • Diabetes insipidus
    a. Desmopressin*

    1. Continuous infusion (preferred)
    2. Intermittent dose

    OR

    b. Vasopressin administered by continuous infusion
  • Volume loading with crystalloid or colloid
  • Inotropic support
    • Dopamine
    • Dobutamine
    • Epinephrine
    • Phenylephrine
    • Norepinephrine
  • Methylprednisolone
  • Bolus dose of levothyroxine followed by continuous infusion OR triiodothyronine infusion
  • Diabetes insipidus
    • Vasopressin administered by continuous infusion
* Desmopressin has a longer half-life than vasopressin. If desmopressin is used, it can be discontinued two to three hours prior to organ recovery, to allow for its metabolism prior to the transplant procedure. Consultation with pediatric intensivists and transplant surgeons should occur to discuss preferences in pharmacologic agents used to maintain hemodynamic stability.
Reproduced with permission from: Nakagawa TA. Updated Pediatric donor management guidelines. NATCO, The Organization for Transplant Professionals, 2008. Copyright © 2008 NATCO.
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