Adult Organ Donor

To increase the number of transplantable organs, UNOS created the Critical Pathway for the Adult Organ Donor, a "care map" or "blue print" of an organ donor's treatment plan. The Critical Pathway is a concise, one-page document, designed to help critical care staff and procurement coordinators understand and follow the steps required for effective donor management.*

After brain death has been declared in potential organ donors and consent is given for donation, donors need to be medically managed to keep their organs viable until organ recovery can occur. The Critical Pathway describes optimal care for the organ donor and maps the process to improve the outcome for successful organ transplantation. The pathway promotes collaboration between organ procurement coordinators and critical care staff and delineates roles to prevent duplication of effort or confusion.

A study has shown that the Critical Pathway, which has been endorsed by four major transplantation associations,** significantly increased the number of organs procured and transplanted from brain dead donors. A study by UNOS researchers (Rosendale, et al.) published in the September 2002 American Journal of Transplantation, demonstrated a 10.3% increase in organs recovered and an 11.3% increase in organs transplanted (1). There is no sacrifice in the quality of the transplanted organs or an increase in donor management time. The Critical Pathway provides cardio-thoracic donor management including hormonal resuscitation.

Go to the Critical Pathway for the Adult Organ Donor

Donation After Cardiac Death

In situations when a patient does not progress to brain death, care is deemed futile, and the family, in concert with the physician, makes the decision to remove the patient from life support, there may be an opportunity for the family to donate organs. The DCD Critical Pathway is a one-page algorithm that graphically defines the donor’s treatment plan from the time of consent until organ recovery takes place. The four major transplantation associations** have endorsed the DCD pathway.

Go to the Critical Pathway for Donation After Cardiac Death

Pediatric Organ Donor

After brain death has been declared, and consent granted for organ donation, pediatric specialists and organ procurement professionals should work together to care for the organ donor and family members. The critical pathway describes optimal care for the pediatric organ donor and maps the process to improve the outcome for successful organ transplantation.

Go to the Critical Pathway for the Pediatric Organ Donor

Supporting Documents for the Critical Pathway

Bibliography

1. Holmquist M., Chabalewski F., Blount T., Edwards, C. McBride V., Pietroski R. Critical Care Nurse, 19(2):84-98, 1999. A Critical Pathway: Guiding Care for Organ Donors.
2. American Journal of Transplantation, 2:761-8, 2002. Increased Transplanted Organs from the Use of a Standardized Donor Management Protocol. UNOS Critical Pathway for the Organ Donor resulted in a 10.3% increase in organs recovered and an 11.3% increase in organs transplanted. There was no reduction in the quality of the organs transplanted.
3. Circulation 106:836-41, 2002. Consensus Conference Report: Maximizing Use of Organs Recovered from the Cadaveric Donor: Cardiac Recommendations. Heart donor criteria and a donor management algorithm for heart recovery.
4. Abstract, International Congress of the Transplantation Society. Hormonal Resuscitation Yields More Transplanted Hearts with Improved Early Function. Hearts from hormonal resuscitation donors had significantly reduced early graft dysfunction and one-month patient mortality.

*This document includes information about cardio-thoracic donor management and details of hormonal resuscitation.
**The Critical Pathway for the Organ Donor protocol has been endorsed by the AOPO, AST, ASTS, and NATCO.

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