Table 1:

Summary of recommendations

Cardiovascular performance, monitoring and hemodynamic support
Vasoactive medications
  • We suggest intravenous vasopressin as a first-line vasoactive agent for hypotension (conditional recommendation, very low-certainty evidence).

  • We suggest intravenous norepinephrine as a second-line agent for hypotension not responding to vasopressin alone (conditional recommendation, very low-certainty evidence).

  • We suggest against the use of dopamine at any dose (conditional recommendation, low-certainty evidence).

  • We make no recommendation regarding other vasoactive medications and inotropes.

Antihypertensive medications
  • We suggest using short-acting intravenous antihypertensive agents as per standard ICU practice to prevent end-organ damage (conditional recommendation, very low-certainty evidence).

Minimal acceptable blood pressure target
  • We suggest maintaining mean arterial pressure ≥ 65 mm Hg rather than a lower threshold (conditional recommendation, very low-certainty evidence).

Fluid resuscitation
  • We suggest infusing crystalloids, rather than colloids, for plasma-volume expansion (conditional recommendation, low-certainty evidence).

Protocolized fluid management
  • We make no recommendation regarding the use of fluid management protocols.

Glycemic control and nutrition
Glucose control
  • We suggest maintaining serum glucose levels in the range of 6–10 mmol/L, rather than a lower range of 4–6 mmol/L (conditional recommendation, very low-certainty evidence).

Glucose, insulin and potassium administration
  • We suggest against the infusion of combined solutions of glucose, insulin and potassium (conditional recommendation, very low-certainty evidence).

Nutritional support
  • We suggest providing enteral nutrition as compared with no nutritional support (conditional recommendation, very low-certainty evidence).

Diabetes insipidus and hypernatremia
Serum sodium control
  • We suggest maintaining serum sodium concentration in the normal range (135–155 mmol/L) (conditional recommendation, very low-certainty evidence).

Diabetes insipidus and vasopressin
  • We suggest treating diabetes insipidus with desmopressin or vasopressin during hemodynamic stability (conditional recommendation, very low-certainty evidence).

  • We suggest treating diabetes insipidus with vasopressin during hemodynamic instability (conditional recommendation, very low-certainty evidence).

Hormonal therapy
Thyroid hormone
  • We suggest against routine thyroid hormone supplementation (conditional recommendation, low-certainty evidence).

  • We make no recommendation about thyroid hormone supplementation for hemodynamic instability or cardiac dysfunction.

Corticosteroids
  • We suggest intravenous corticosteroid therapy for donors requiring vasopressor support (conditional recommendation, low-certainty evidence).

  • We make no recommendation about high-dose corticosteroid therapy for potential lung donors.

Transfusion therapy
Transfusion threshold
  • We suggest withholding red blood cell transfusions unless hemoglobin levels fall below 70 g/L (conditional recommendation, very low certainty in evidence).

Correction of coagulopathy and thrombocytopenia
  • We suggest that in the absence of clinically significant bleeding, transfusions of fresh frozen plasma be withheld altogether, and that platelet transfusions be withheld unless platelet levels fall below 10 × 109/L (conditional recommendation, very low certainty in evidence).

Bacterial infections
Antibiotics
  • We suggest reserving antibiotic therapy for the treatment of known or suspected infection (conditional recommendation, very low-certainty evidence).

Routine cultures
  • We suggest that screening cultures of blood, urine and sputum be performed at intervals consistent with general ICU practice and patient clinical status (conditional recommendation, very low-certainty evidence).

Organ-specific considerations: heart, lungs and intra-abdominal organs
Cardiac assessment tools
  • We suggest against routine use of pulmonary artery catheters (conditional recommendation, very low-certainty evidence).

  • We suggest serial echocardiography at intervals consistent with general ICU practice (conditional recommendation, very low-certainty evidence).

Cardiac biomarkers
  • We suggest against the measurement of serum cardiac biomarkers (conditional recommendation, very low-certainty evidence).

Coronary angiography
  • We suggest against routine coronary angiography (conditional recommendation, very low-certainty evidence).

  • Coronary angiography should be performed in the presence of risk factors for coronary artery disease as determined according to local criteria (good practice statement).

Lung-protective ventilation
  • We recommend a lung-protective ventilation strategy consisting of low tidal volumes (6–8 mL/kg), high positive end-expiratory pressure (at least 8 cm H20) and recruitment manoeuvres after ventilator disconnections in potential lung donors (strong recommendation, moderatecertainty evidence).

Bronchoscopy
  • We suggest diagnostic bronchoscopy be performed for potential lung donors (conditional recommendation, low-certainty evidence).

Inhaled β-agonist therapy
  • We suggest against routine use of inhaled β-agonists (conditional recommendation, moderate-certainty evidence).

Chest radiography and computed tomography scan
  • We suggest a single routine diagnostic chest radiograph for lung donors and additional chest imaging as clinically indicated (conditional recommendation, low-certainty evidence).

Albumin: creatinine ratio screening
  • We suggest using the albumin:creatinine ratio for detecting microalbuminuria when assessing potential kidney donors with type 1 or 2 diabetes mellitus (conditional recommendation, very low certainty in evidence).

Hemoglobin HbA1c testing
  • We suggest that hemoglobin HbA1c testing be performed in potential donors being considered for pancreas donation (conditional recommendation, very low-certainty evidence).

Abdominal imaging
  • We suggest that abdominal CT or ultrasound should be used only in those with age > 50 yr, comorbid conditions, high body mass index, or clinical history of malignancy (conditional recommendation, low-certainty evidence).

Other therapeutic interventions
Therapeutic hypothermia
  • We suggest maintaining the core body temperature in the range of 34°C–35°C, unless kidneys will not be used for transplantation, in which case normothermia is appropriate (conditional recommendation, low-certainty evidence).

Duration of donor management
  • For potential donors with acute organ injury, we make no recommendation regarding timing of organ recovery surgery or optimal duration of ICU donor management (conditional recommendation, very low-certainty evidence).

  • Note: CT = computed tomography, HbA1c = glycosylated hemoglobin, ICU = intensive care unit.