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Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement

Kotloff, Robert M. MD1; Blosser, Sandralee MD2; Fulda, Gerard J. MD3; Malinoski, Darren MD4; Ahya, Vivek N. MD5; Angel, Luis MD6; Byrnes, Matthew C. MD7; DeVita, Michael A. MD8; Grissom, Thomas E. MD9; Halpern, Scott D. MD5; Nakagawa, Thomas A. MD10; Stock, Peter G. MD11; Sudan, Debra L. MD12; Wood, Kenneth E. DO13; Anillo, Sergio J. MD14; Bleck, Thomas P. MD15; Eidbo, Elling E. MBA16; Fowler, Richard A. MBA16; Glazier, Alexandra K. JD, MPH17; Gries, Cynthia MD18; Hasz, Richard MFS, CPTC19; Herr, Dan MD20; Khan, Akhtar MD21; Landsberg, David MD22; Lebovitz, Daniel J. MD23; Levine, Deborah Jo MD6; Mathur, Mudit MD24; Naik, Priyumvada MD25; Niemann, Claus U. MD11; Nunley, David R. MD26; O’Connor, Kevin J. MS27; Pelletier, Shawn J. MD28; Rahman, Omar MD29; Ranjan, Dinesh MD30; Salim, Ali MD31; Sawyer, Robert G. MD28; Shafer, Teresa RN, MSN32; Sonneti, David MD33; Spiro, Peter MD34; Valapour, Maryam MD1; Vikraman-Sushama, Deepak MD12; Whelan, Timothy P. M. MD35

doi: 10.1097/CCM.0000000000000958
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This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations. Under the auspices of these societies, a multidisciplinary, multi-institutional task force was convened, incorporating expertise in critical care medicine, organ donor management, and transplantation. Members of the task force were divided into 13 subcommittees, each focused on one of the following general or organ-specific areas: death determination using neurologic criteria, donation after circulatory death determination, authorization process, general contraindications to donation, hemodynamic management, endocrine dysfunction and hormone replacement therapy, pediatric donor management, cardiac donation, lung donation, liver donation, kidney donation, small bowel donation, and pancreas donation. Subcommittees were charged with generating a series of management-related questions related to their topic. For each question, subcommittees provided a summary of relevant literature and specific recommendations. The specific recommendations were approved by all members of the task force and then assembled into a complete document. Because the available literature was overwhelmingly comprised of observational studies and case series, representing low-quality evidence, a decision was made that the document would assume the form of a consensus statement rather than a formally graded guideline. The goal of this document is to provide critical care practitioners with essential information and practical recommendations related to management of the potential organ donor, based on the available literature and expert consensus.

Supplemental Digital Content is available in the text.

1Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH.

2Division of Pulmonary, Allergy, and Critical Care Medicine, Penn State Hershey Medical Center, Hershey, PA, and Pittsburgh Critical Care Associates, Pittsburgh, PA.

3Department of Surgery, Christiana Care Health System, Newark, DE.

4Department of Surgery, Portland Veterans Affairs Medical Center, Portland, OR.

5Pulmonary, Allergy, and Critical Care Division, Hospital of the University of Pennsylvania, Philadelphia, PA.

6Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Center at San Antonio, San Antonio, TX.

7Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN.

8General Surgery Department, Harlem Hospital Center, New York, NY.

9Department of Anesthesiology, University of Maryland Medical Center, Baltimore, MD.

10Section of Pediatric Critical Care, Wake Forest Baptist Health Medical Center, Winston-Salem, NC.

11Department of Surgery, University of California, San Francisco, San Francisco, CA.

12Department of Surgery, Duke University Medical Center, Durham, NC.

13Geisinger Medical Center, Danville, PA.

14SUNY Buffalo, Buffalo, NY.

15Department of Neurology, Rush Medical College, Chicago, IL.

16Association of Organ Procurement Organizations, Vienna, VA.

17New England Organ Bank, Waltham, MA.

18Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.

19Gift of Life, Philadelphia, PA.

20Department of Medicine, University of Maryland Medical Center, Baltimore, MD.

21Department of Surgery, Alleghany General Hospital, Pittsburgh, PA.

22Department of Emergency Medicine, SUNY Upstate Medical Center, Syracuse, NY.

23Department of Pediatric Critical Care Medicine, Akron Children’s Hospital, Akron, OH.

24Department of Critical Care Medicine, Loma Linda University Children’s Hospital, Loma Linda, CA.

25Intensivist, Atlanta, GA.

26Division of Pulmonary and Critical Care Medicine, University of Louisville Hospital, Louisville, KY.

27LifeCenter Northwest, Bellevue, WA.

28Department of Surgery, University of Virginia Health System, Charlottesville, VA.

29Pulmonary and Critical Care, Indiana University Health System, Indianapolis, IN.

30Department of Surgery, Oscar G. Johnson Veterans Administration Medical Center, Iron Mountain, MI.

31Trauma, Burns, and Surgical Critical Care Division, Brigham and Women’s Hospital, Boston, MA.

32Texas Transplantation Society, Austin, TX.

33Division of Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI.

34Pulmonary Department, Harlem Hospital, New York, NY.

35Division of Pulmonary, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, SC.

The American College of Critical Care Medicine (ACCM), which honors individuals for their achievements and contributions to multidisciplinary critical care medicine, is the consultative body of the Society of Critical Care Medicine (SCCM) that possesses recognized expertise in the practice of critical care. The College has developed administrative guidelines and clinical practice parameters for the critical care practitioner. New guidelines and practice parameters are continually developed, and current ones are systematically reviewed and revised.

These guidelines have been reviewed and endorsed by the American Association of Critical Care Nurses, the American Society of Transplantation, and the United Network of Organ Sharing.

All task force participants were required to submit conflict of interest statements.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Supported, in part, by the Society of Critical Care Medicine, American College of Chest Physicians, and Association of Organ Procurement Organizations.

Dr. Malinoski consulted for the Organ Donation and Transplantation Alliance, lectured for multiple organ procurement organizations, and disclosed government work. His institution received grant support from Health Resources and Services Administration (HRSA). Dr. Ahya consulted for Catapult Consulting (the entity is contracted by Centers for Medicare and Medicaid Services to review lung transplant programs with lower than expected outcomes) and received royalties from UptoDate (Lung Transplant section in UptoDate). Dr. Byrnes is employed by the Saint Catherine Hospital. Dr. Nakagawa received royalties from UpToDate and consulted for the U.S. Department of Health and Human Services, HRSA, and the Organ Donation and Transplantation Alliance. Dr. Wood and his institution received grant support from Agency for Healthcare Research and Quality grants. Mr. Eidbo has disclosed that he is executive director of the Association of Organ Procurement Organizations (AOPO). Mr. Fowler received support for article writing/review from the AOPO (led AOPO’s expert review of the article and associated revisions), consulted for the AOPO (independent consultant—relevant client during the time period) and the Washington Regional Transplant Community (independent consultant—relevant client during the time period), and has stock in Johnson & Johnson. Dr. Gries received support for travel from American Society of Transplantation (travel to Board of Directors meeting, travel to give talk). Her institution received grant support from PneumRx. Dr. Mathur is employed by the Faculty Physicians and Surgeons of Loma Linda University School of Medicine. His institution received grant support from the National Heart, Lung and Blood Institute (the Therapeutic Hypothermia after Pediatric Cardiac Arrest trials). Dr. Niemann served as a board member for the International Liver Transplant Society, consulted for MedSleuth, is employed by University of California, San Francisco, has stock options with MedSleuth (nothing paid), and received support for article research from HRSA. He and his institution received grant support from HRSA. Dr. Salim’s institution received grant support from National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Sonetti is employed by the University of Wisconsin Hospital and Clinic, University of Wisconsin Medical Foundation, and the William S. Middleton Memorial Veteran Hospital (Madison, WI). Dr. Valapour is employed by the University of Minnesota and the Cleveland Clinic and received support for article research from the National Institutes of Health (the topic was covered by this article but the funding was not for this particular project). She and her institution received Federal grant support (investigator for Scientific Registry of Transplant Recipients). Dr. Whelan consulted for LifePoint (Organ Procurement Organization of South Carolina). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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