Critical care management of the brain-dead organ donor

The majority of organs transplanted in the United States are from brain-dead donors. The patients are usually located in an intensive care unit at the time of declaration of brain death. Adequate clinical management of these patients is of the utmost importance, because the viability of the transplanted organ can be profoundly affected. The physiologic changes caused by brain death cause numerous hemodynamic and metabolic alterations. Hemodynamic changes are mostly related to hypotension and hypoperfusion. Fine adjustments in fluid administration and judicious use of vasopressors, such as dopamine, and inotropes such as dobutamine, can maintain hemodynamic stability. Replacement of hormones, mainly vasopressin and thyroxin, further contributes to stability. These maneuvers require a critical care philosophy for successful preservation of organ viability.