1. Kayyali, Andrea MSN, RN

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Intensive management yields success.

In response to the increasing demand for viable donated organs, a California institution developed an aggressive, anticipatory, and rigorous approach to the management of the care provided to patients who might serve as donors (those with traumatic and nontraumatic severe head injuries that could lead to brain death), and assessed outcomes in that population before and after its implementation. The policy, known as Aggressive Donor Management (ADM), increased both the number of patients referred for organ donation and the number of organs donated.


ADM, implemented in January of 1999, outlines a set of guidelines to be followed once a patient is identified as a possible organ donor, beginning with prompt provision of critical care upon arrival of any critically brain-injured patient at the ED. In the protocol to be followed once the patient is admitted to the surgical ICU, a pulmonary artery catheter is inserted, cardiovascular resuscitation with fluids is attempted, and vasopressor therapy is administered if the mean arterial pressure still is lower than 70 mmHg despite fluid resuscitation. If vasopressors are initiated, IV hormonal therapy is also administered to promote hemodynamic stability. Other therapeutic interventions are used, as necessary, according to arising complications. The critical care team does not address the topic of organ donation with the patient's family; rather, an organ donation specialist from a regional organ procurement organization is contacted to handle the discussion.


The researchers evaluated the institution's donation records from the period 1995 to 2002, comparing the ones from 1995 to 1998 (prior to initiation of ADM) with those from 1999 to 2002 (after initiation), and determined that donation referrals increased by 57% in the years after implementation of the policy, and the number of possible donors who did donate organs increased by 82%. Overall, the number of organs procured increased by 71%. The authors attribute the accomplishments partly to the emphasis placed on hemodynamic management of the unstable patients, which decreased by 87% the number of donors lost to hemodynamic instability.


The ADM policy has proven successful in improving the record of organ donations at one institution. Nurses working with trauma patients can have a significant effect on increasing the number of such donations through the prompt identification of possible donors and the provision of hemodynamic management and interventions that prevent complications of hemodynamic instability associated with brain death.


Salim A, et al. J Trauma 2005;58(5):991-4.