Hormonal replacement therapy for the pediatric organ donor

Drug	Dose	Route	Comments
Desmopressin (DDAVP)	0.5 micrograms/hour	IV	Half-life 75 to 120 minutes Titrate to decrease urine output to 3 to 4 cc/kg/hour May be beneficial in patients with an ongoing coagulopathy
Vasopressin (Pitressin)	0.5 to 1 milliunits/kg/hour	IV	Half-life 10 to 35 minutes Titrate to decrease urine output to 3 to 4 cc/kg/hour Hypertension can occur
Treatment of diabetes insipidus should consist of pharmacologic management to decrease but not completely stop urine output. Replacement of urine output with 1/4 or 1/2 normal saline should be used in conjunction with pharmacologic agents to maintain serum sodium levels between 130 to 150 meq/L.
Levothyroxine (Synthroid)	0.8 to 1.4 micrograms/kg/hour (maximum dose 20 micrograms/hour)	IV	Bolus dose 1 to 5 micrograms/kg can be administered (maximum bolus dose 20 micrograms) Infants and smaller children require a larger bolus and infusion dose
Triiodothyronine (T3)	0.05 to 0.2 micrograms/kg/hour	IV
Methylprednisolone (Solu-Medrol)	20 to 30 mg/kg (maximum dose 2 g)	IV	Dose may be repeated in 8 to 12 hours Fluid retention Glucose intolerance
Insulin	0.05 to 0.1 units/kg/hour	IV	Titrate to control blood glucose levels to 60 to 150 mg/dL Monitor for hypoglycemia
Hormonal replacement therapy should be considered early in the course of donor management. Use of hormonal replacement therapy may allow weaning of inotropic support and assist with metabolic stability for the pediatric donor.

IV: intravenous.

Adapted with permission from: Nakagawa, TA. Pediatric donor management guidelines. NATCO, The Organization for Transplant Professionals, 2008. p.4.

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