Peroperative fluid management of the brain-dead multiorgan donor

Brain-dead organ donors are often dehydrated and have serum electrolyte disorders. This study was designed to analyse the haemodynamic condition and serum electrolyte balance of liver donors. Two different fluid management plans for the harvesting operation were studied. Sixteen consecutive organ donors were included. They were randomly infused either with a combination of colloid (hydroxy ethyl starch) and electrolyte solution (group COL) or with crystalloid fluid alone (group CR). Arterial pressures, heart rate, central venous pressure and oesophageal temperature were monitored and serum electrolytes were analysed before the beginning of the operation and during harvesting. The amount of fluid needed in the COL group was significantly less (P less than 0.01) than in the CR group. There were no statistical differences between the groups in the haemodynamic parameters during the study period. The oesophageal temperature was maintained in both groups. All donors were initially hypernatraemic, but the serum sodium values returned towards normal during surgery in both groups. Immediate function was seen in all livers. In conclusion, the haemodynamic stability is maintained with a smaller infused volume if hydroxyethyl starch is combined with crystalloid fluids. The formation of interstitial oedema will be less when colloids are used, but its significance in organ donation needs further evaluation.