Management of the Organ Donor

Advances in immunosuppressive therapy have led to increased use of organ transplantation to treat end- organ failure. This has led to a consistent shortage of transplantable organs, with many patients dying while awaiting heart, liver, or lung transplantation. Traditional donor criteria are expanding and increase the pool of available donor organs. The organ procurement process often begins with the diagnosis of brain death, which must be made by clinical criteria and is usually con firmed by clinical testing. Because brain-dead patients suffer a variety of hemodynamic, cardiac, endocrine, respiratory, and hematologic abnormalities, manage ment in the intensive care unit demands meticulous attention and expertise. Living and, occasionally, non- heart-beating donors are also a source of donor organs. Management of the various types of donors in the operating room requires specific skills and knowledge. The persistent need for donor organs requires that poten tial organ donors be recognized and appropriately man aged to maximize the pool of available organs for the ever- increasing number of potential organ recipients.