Critical care pharmacy in donor management

Significant systemic changes occur following neurologic insult and subsequent brain death. If left untreated, the hemodynamic instability and neuroendocrine alterations that ensue may significantly affect the quality of the donor organs, and contribute to posttransplant allograft dysfunction. A number of pharmacologic interventions are often implemented in an attempt to stabilize donor hemodynamics and optimize organ perfusion, thereby increasing the number and quality of cadaveric donor organs available for transplantation. This review provides a summary of these interventions, with an emphasis placed on hormonal resuscitation, which involves utilizing such agents as thyroxin, vasopressin, insulin, and corticosteroids.