**3. Donor management**

The goals of donor management before a heart transplant include maintaining adequate intravenous volume with optimum cardiac filling pressure and ensuring adequate arterial pressure for entire organ perfusion. Arterial and central venous pressure (CVP) lines are essential and should be placed for continuous hemodynamic monitoring and allow blood samples to be obtained as needed. CVP is maintained in the range of 6–10 mmHg to ensure adequate volume status and mean arterial pressure is targeted between 60 and 80 mmHg. All cardiac donors should have an echocardiogram to evaluate cardiac function, LV wall thickness, wall motion and exclude any major structural heart defects. A coronary angiogram is recommended for donors >40 years old or with risk factors for coronary artery disease (smoking, hypertension, hyperlipidemia and methamphetamine users) [12].

Factors contributing to volume depletion include unrecognized blood loss associated with trauma, diminished vascular tone, hyperosmotic therapy from mannitol, third spacing generated by inflammatory mediators, hyperglycemia and diabetes insipidus (DI) resulting in massive diuresis. A total of 0.9% NaCl or Lactated Ringer's solution is generally used in case of fluid depletion. In donors with hypernatremia, 0.45% NaCl or dextrose-containing crystalloids can be used for fluid repletion.

Despite adequate fluid repletion, progressive systemic hypotension still occurs in brain-dead donors requiring vasopressors and inotropes support. Many studies have suggested vasopressin as a first-line drug given simultaneously decreasing DI and catecholamine agonist (V1 and V2) actions [12–14]. Low doses of dopamine may be used as an alternative drug. The study demonstrated the use of dopamine in both

*Heart Preservation Techniques for Transplantation DOI: http://dx.doi.org/10.5772/intechopen.113937*

kidney and heart transplants was associated with less requirement of postoperative dialysis [15]. Beta agonist treatment should be avoided given the effect of β-receptors down-regulation and subsequently impaired cardiac function post-transplantation [16]. Moreover, hormonal resuscitation (cortisol, anti-diuretic hormone, insulin and thyroid hormone) has been recommended in brain-dead donors [12, 13].
