Clinical protocol for management of potential organ donors with brain death
https://doi.org/10.20340/vmi-rvz.2025.4.PROT.1
Abstract
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.
Keywords
brain death [D001926],
tissue donors [D014019],
organ transplantation [D016035],
critical care [D003422],
hemodynamic support [D006439],
hormone replacement therapy [D020249],
hypernatremia [D006955],
infectious complications [D007239],
physiological monitoring [D008991],
donor management goals [D019984]
About the Authors
B. I. Yaremin
N.V. Sklifosovsky Research Institute of Emergency Medicine;
Pirogov Russian National Research Medical University;
National Medical Research Center of Oncology named after N.N. Blokhin
Russian Federation
Competing Interests:
Russian Federation
Boris I. Yaremin, Cand. Sci. (Med.), surgeon and researcher of the Liver Transplant Center; Associate Professor, Head of the Academic Department of the Department of Transplantology and Artificial Organs of the Institute of Biomedicine (IBF); Head of the Department for Coordination of Organ and/or Tissue Donation; Head of the Department of Surgical Diseases.
Author contribution: preparation of the protocol text.
Bolshaya Sukharevskaya Square, 3, Moscow, 129090;
Ostrovityanova St., 1, Moscow, 117513;
Kashirskoe shosse, 23, Moscow, 115522
Competing Interests:
The authors declare no competing interests. B.I. Yaremin is the executive secretary of the editorial board of the journal. I did not take part in the decision to publish the work.
K. K. Gubarev
Federal Medical Biophysical Center named after A.I. Burnazyan
Russian Federation
Competing Interests:
Russian Federation
Konstantin K. Gubarev, Head of the Surgical Department for Coordination of Human Organ and (or) Tissue Donation
Author contribution: preparation of the protocol text.
Marshal Novikov St., 23, Moscow, 123098
Competing Interests:
The authors declare no competing interests. B.I. Yaremin is the executive secretary of the editorial board of the journal. I did not take part in the decision to publish the work.
A. K. Shabanov
N.V. Sklifosovsky Research Institute of Emergency Medicine
Russian Federation
Competing Interests:
Russian Federation
Aslan K. Shabanov, Dr. Sci. (Med.), Professor, Deputy Chief Physician for Anesthesiology and Resuscitation
Author's contribution: protocol preparation.
Bolshaya Sukharevskaya Square, 3, Moscow, 129090;
Competing Interests:
The authors declare no competing interests. B.I. Yaremin is the executive secretary of the editorial board of the journal. I did not take part in the decision to publish the work.
R. P. Lavrinyuk
Brest Regional Clinical Hospital
Belarus
Competing Interests:
Belarus
Rostislav P. Lavrinyuk, Head of the Department for Coordination of Organ and Tissue Collection for Transplantation
Author contribution: preparation of the protocol text
Meditsinskaya St., 7, Brest, 224027
Competing Interests:
The authors declare no competing interests. B.I. Yaremin is the executive secretary of the editorial board of the journal. I did not take part in the decision to publish the work.
K. V. Grozovskiy
National Center for Transplant Coordination, Hadassah Hospital
Israel
Competing Interests:
Israel
Kirill V. Grozovsky, Transplant Coordinator
Author's contribution: protocol preparation.
Kiryat Hadassah, Jerusalem, 91120
Competing Interests:
The authors declare no competing interests. B.I. Yaremin is the executive secretary of the editorial board of the journal. I did not take part in the decision to publish the work.
Review
For citations:
Yaremin B.I., Gubarev K.K., Shabanov A.K., Lavrinyuk R.P., Grozovskiy K.V. Clinical protocol for management of potential organ donors with brain death. Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH). 2025;15(4):201-213. (In Russ.) https://doi.org/10.20340/vmi-rvz.2025.4.PROT.1
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