[Adequate preservation of organs in brain-dead patients with a view to transplantation]

There exists a shortage of donor organs. Inadequate medical treatment of brain-dead patients results in one-third of the available organs not being suitable for transplantation. Adequate preservation of organs in brain-dead patients increases the supply and quality of donor organs. This preservation comprises the following measures: management of hypotension with a view to adequate perfusion of the organs (administration of fluid, if necessary erythrocytes, and of sympathicomimetic agents); adjustment of artificial respiration to the reduced carbon dioxide production in the tissues (lowering the respiratory minute volume) and to desired oxygenation (positive end-expiratory pressure, increase of the proportion of oxygen in the inhaled air, lengthening of the inspiration time); preventing excessive cooling of the body of the brain-dead patient due to failure of the temperature regulation (heating blanket, heating mattress, warming infusion fluids and inhaled air); treatment of diabetes insipidus in hypophyseal insufficiency (intravenous desmopressin); prevention and treatment on infections (antibiotics, bronchial toilet, variation of position).