_____________ Supporting Organ and Tissue Donation in Clinical Settings: The Pennsylvania Requirement
Lung-protective ventilation has been shown to improve lung function and increase the number of lungs ultimately transplanted [26; 31]. Recommended airway pressure release ventilation (APRV) settings should be [31]: 1. Set P High using the PIP of the previous PC mode or at the peak plateau pressure of the previous VC mode ‒ A plateau pressure is obtained by performing an inspiratory hold. ‒ Set to a minimum of 20 cm H 2 0 but avoid exceeding 35 cm H 2 0. ‒ Make adjustments in 2-cm H 2 0 increments to maintain mean arterial pressure 25–28. 2. Set P Low to 0. 3. Set T High, initially between 4 to 6 seconds. 4. Set T Low, initially between 0.5 to 0.8 seconds. ‒ Set to achieve an expiratory flow rate termination that is 50% of the peak expiratory flow. ‒ Consult respiratory therapy for assistance. 5. Recheck arterial blood gas in two hours after initial change and then every four hours, and make adjustments as need to obtain optimal oxygenation and a normal pH. The first arterial blood gas measurements in APRV may be worse than the baseline. Keep in mind that full recruitment may take four to six hours [31]. Temperature Management Hypothermia accelerates coagulation, impairs cardiac function, and complicates hemodynamic management. Active warm- ing measures, including warm IV fluids, external warming blankets, and heated/humidified ventilator circuits, should be initiated to maintain core temperature ≥36°C. Laboratory Monitoring Frequent laboratory monitoring is critical during the donor management period. Recommended assessments every four to six hours include: ABG, BMP, CBC, coagulation studies (PT/ INR, aPTT, fibrinogen), lactate, liver function tests, and cardiac enzymes. Urine output should be monitored hourly. Trends should be communicated to the OPO coordinator in real time.
CONCLUSION Effective donor management is a team endeavor. The ICU attending physician and nursing staff manage the patient’s physiologic parameters, while the OPO coordinator serves as a resource, advocate, and logistics coordinator. Surgeons, respira- tory therapists, and pharmacists may all play active roles. Clear, proactive communication among all team members, including consistent shift-to-shift handoff that emphasizes donor status and DMG attainment, is essential to maximizing outcomes.
WORKS CITED https://qr2.mobi/organ-tissue
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