Optimal Management of Brain Death Donor

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Since the Harvard criteria for brain death was proposed in 1968, deceased donor, mainly brain death donor (BD), organ transplantation has been performed worldwide and given the chance for a new life to patients suffering from end-stage organ disease. In Korea by the eager efforts promoting brain-dead organ donation, fortunately, the number of organ donations from the brain-dead has increased successfully in the last decade. However, the disparity between the number of patients awaiting organ transplantation on the list and the number of actual organ donations has become wider and the organ shortage remains a limitation for new lives by transplantation. Because of donor organ restriction, optimal management of brain-dead donors is increasingly important. In addition, the favorable clinical outcomes of recipients is directly associated with the well-preserved organ function of brain-dead donors, which can be accomplished by the maintenance of optimal perfusion. However the brain-dead condition leads to various and profound pathophysiological changes in the neuroendocrine and cardiovascular systems, and management of brain-dead organ donors usually includes active intensive care for maintaining organ function. Therefore, to enhance the potential organ graft function and increase the organ supply, physicians must have knowledge of the pathophysiology of brain death and must deal with rapid hemodynamic changes, endocrine and metabolic abnormalities, and respiratory complications. This article reviews the pathophysiologic changes resulting from brain death and the adequate management for maximizing use of organs recovered from brain death donors.