Current practices in deceased organ donor management

Optimizing the management of deceased organ donors focuses on providing critical care that prevents, mitigates, or repairs the pathophysiologic sequelae of brain death. This review discusses protocol-based care; approaches to monitoring, resuscitation, hormone replacement therapy, and respiratory management; and the potential of various additional donor therapies.

Protocol-based critical care after the determination of brain death has the potential to substantially increase the quantity and improve the quality of organs available for transplantation. Close hemodynamic monitoring with timely resuscitation using isotonic fluid replacement as well as adjunctive vasoactive and hormone replacement therapy in the persistently hemodynamically unstable donor is recommended. Convincing evidence suggests that mild therapeutic hypothermia of the donor can be adopted to reduce delayed graft function in the renal transplant recipient.

There continues to be a limited number of current published reports pertaining to deceased organ donor management, with many practices still based on consensus statements. Recent endorsement and recommendations for conducting donor intervention research have provided a framework for future studies, which have potential to lead to the publication of quality results so that more evidence-based guidelines can be developed.