Management of the brainstem dead organ donor: Pathophysiology and donor optimization

Abstract

Transplantation of vital human organs is a life saving therapy for patients with end-stage organ failure. However, donor management remains one of the most neglected areas in transplantation medicine. Brainstem death leads to heamodynamic, metabolic and immune perturbations. Failure to provide adequate physiological support during this time accounts for at least 25% of lost donor organs. Donor optimization leads to increased organ procurement and contributes to improved organ function in the recipient. This article reviews the management of the brainstem dead donor from intensive care through organ procurement whilst highlighting advances and controversies in donor care.