Decisions over suitability of a donor typically are left to established organizations that differ for each hospital
General contraindications
Any kind of cancer (EXCEPT skin cancers other than melanoma, certain primary<unk>  tumors). Essentially this means only cancers with very low risk of metastasis are acceptable
Any kind of systemic infection or communicable incurable disease
Active Fungal disease (Cryptoccous, Aspergillus, Histoplasma, Coccidioides, Candidemia, invasive yeast)
Active Bacterial infection (Tb, sepsis)
Viral infections (HIV, HTLV, rabies, reactive HbsAg, West nile, SARS, enterovirus, HSV, VZV, EBC etc)
Any kind of cancer (EXCEPT skin cancers other than melanoma, certain primary<unk>  tumors). Essentially this means only cancers with very low risk of metastasis are acceptable
Any kind of systemic infection or communicable incurable disease
Active Fungal disease (Cryptoccous, Aspergillus, Histoplasma, Coccidioides, Candidemia, invasive yeast)
Active Bacterial infection (Tb, sepsis)
Viral infections (HIV, HTLV, rabies, reactive HbsAg, West nile, SARS, enterovirus, HSV, VZV, EBC etc)
The general goals with organ donation are organ preservation by maintaining: 1) Physiologic levels of neuro mediated hormones, 2) Blood pressure, 3) Obtaining Screening labs
Pan-hypopituitary state
Diabetes insipidus
Clinical: DI typically presents with UOP >5cc/kg/hr. Urine Spec Grav: < 1.005, serum Na > 145 or serum osmolality > 305mg/dL
Treatment: Frequent Na monitoring. Bolus vasopressin 0.5U IV then drip with goal of 0.5U/h. Titrate to UOP 1-2ml/kg/h
Hypothyroidism - 20 mcg T4 IV bolus, then T4 at 10 mcg/hr, which may cause hyperkalemia so administer 10 U regular insulin with 1 amp 50% dextrose before IV bolus
Hypoinsulinemia - Insulin drip, titrate to maintain glucose 80-110 with q1 hr checks
Hypocortisol, adrenal insufficiency - treatment - 15 mg/kg IV bolus QD empirically
Hypotension
Place arterial line with goal SBP > 90, MAP > 60
If goals are not met. a continuous cardiac index monitor (Vigileo or PICCO) may be indicated. Goals are CI > 2.5 and UOP > 1 ml/kg/hr
Consider starting inotropes, to include dobutamine or milrinone
If MAP < 60 despite adequate CI, start peripheral pressor (phenylephrine or norepinepherine)
Place central line with CVP goals > 5 mmHg
Maintain fluids at 1.5-2 ml/kg/hr. Choice of fluids include NS for Na < 155, 1/2-NS for Na 156-165, D5W if Na > 165
Screening labs
HIV 1/2, HTLV 1 and 2, RPR, Toxoplasma IgG, CMV IgG, EBV IgG, VZV IgG, HSV 1 and 2, Hepatitis A/B/C
LFTs, amylase, lipase, CBC, coagulation profile
Diabetes insipidus
Clinical: DI typically presents with UOP >5cc/kg/hr. Urine Spec Grav: < 1.005, serum Na > 145 or serum osmolality > 305mg/dL
Treatment: Frequent Na monitoring. Bolus vasopressin 0.5U IV then drip with goal of 0.5U/h. Titrate to UOP 1-2ml/kg/h
Hypothyroidism - 20 mcg T4 IV bolus, then T4 at 10 mcg/hr, which may cause hyperkalemia so administer 10 U regular insulin with 1 amp 50% dextrose before IV bolus
Hypoinsulinemia - Insulin drip, titrate to maintain glucose 80-110 with q1 hr checks
Hypocortisol, adrenal insufficiency - treatment - 15 mg/kg IV bolus QD empirically
Clinical: DI typically presents with UOP >5cc/kg/hr. Urine Spec Grav: < 1.005, serum Na > 145 or serum osmolality > 305mg/dL
Treatment: Frequent Na monitoring. Bolus vasopressin 0.5U IV then drip with goal of 0.5U/h. Titrate to UOP 1-2ml/kg/h
Place arterial line with goal SBP > 90, MAP > 60
If goals are not met. a continuous cardiac index monitor (Vigileo or PICCO) may be indicated. Goals are CI > 2.5 and UOP > 1 ml/kg/hr
Consider starting inotropes, to include dobutamine or milrinone
If MAP < 60 despite adequate CI, start peripheral pressor (phenylephrine or norepinepherine)
Place central line with CVP goals > 5 mmHg
Maintain fluids at 1.5-2 ml/kg/hr. Choice of fluids include NS for Na < 155, 1/2-NS for Na 156-165, D5W if Na > 165
If goals are not met. a continuous cardiac index monitor (Vigileo or PICCO) may be indicated. Goals are CI > 2.5 and UOP > 1 ml/kg/hr
Consider starting inotropes, to include dobutamine or milrinone
If MAP < 60 despite adequate CI, start peripheral pressor (phenylephrine or norepinepherine)
HIV 1/2, HTLV 1 and 2, RPR, Toxoplasma IgG, CMV IgG, EBV IgG, VZV IgG, HSV 1 and 2, Hepatitis A/B/C
LFTs, amylase, lipase, CBC, coagulation profile
Special Considerations
Heart often experiences stunning myocardium secondary to neurogenic sympathetic surge. Often will lower EF with some myocyte necrosis and troponin leak. Order q6hr serial cardiac enzymes, then repeat echo. Very often heart will recover after initial stunning period
Brain death
Spinal shock
Hemorrhagic shock
Neurogenic shock
Heat exhaustion
Heat stroke
Stroke 
Tumor lysis syndrome