Organ donor management in the ICU: Adjunctive agents for optimizing organ procurement and graft function

This article reviews adjunctive medications utilized to increase the quantity of viable organs available for procurement and optimize donor graft function.

In response to the growing demand for transplantable organs, various procurement methods and adjunctive medications are being explored to improve outcomes. Research in transplantation often involves small patient populations and limited randomized trials, resulting in a paucity of strong evidence for many interventions. The most robust data support fluid, hemodynamic, and hormone therapy management. However, the last comprehensive review of pharmacotherapy commonly utilized for this indication was in 2016. Newer adjuncts-such as naloxone, heparin, and alteplase-are increasingly being incorporated into local protocols. As pharmacists are responsible for verifying appropriate dosing and timing of these medications, it is essential that they remain up to date with the latest literature. Their familiarity with this evolving evidence base enables them to support the medical team and local organ procurement organizations in improving transplantation outcomes.

The literature surrounding strategies to optimize organ donation is continuously evolving. Pharmacotherapy plays a critical role in ensuring positive outcomes, and emerging therapies aim to further expand the available donor pool and improve recipient outcomes. While hemodynamic optimization remains central, newer agents such as naloxone, alteplase, and heparin are gaining relevance in clinical practice.