Brain death-associated pathological events and therapeutic options

At present, organ transplantation is the most efficient treatment of end-stage failure of various organs, including the heart, lungs, pancreas, intestines, kidney, and liver. Despite the efforts to use organs from living donors or from donors after circulatory death, most of the organs are recovered from brain dead (BD) donors.

The Medline and Web of Science databases were searched without time limit on November 2015 using the terms "brain dead donor" and "deceased donor" in conjunction with "transplantation", "graft", "organ", "hemodynamic", "hormonal", or "management". The search was limited to the English, Polish and Spanish literature. Articles that did not address the topics were excluded and the full text of the remaining articles was reviewed.

It is well established that brain death is associated with a cascade of hemodynamic, inflammatory, and immunologic events that affect the outcome of transplanted organs. Proper management of the potential organ donor may help increase the supply of organs for transplantation. However, because there is a lack of good quality evidence, it is difficult to establish specific BD donor management guidelines.

In this paper we present a review of studies and literature concerning the detrimental impact of donor brain death on graft function. We present pathologic changes that take place after brain death, their influence on graft quality and therapeutic solutions to enhance transplanted organ function.