Management of the potential organ donor

Management of the potential organ donor in critical care units is the most immediate and practical solution to the current crisis in organ donation. Brain death physiology significantly impacts upon the management process. Cardiovascular support is the cornerstone of donor management because it ensures donor somatic survival for procurement and maintains all of the donor organs in the best possible conditions. General applications of cardiovascular management for critically ill patients are applicable to donor management and include invasive monitoring and adjustment of vasoactive medications. Adjudicating the delicate balance between the adequacy of fluid resuscitate for organ perfusions versus minimizing the extravascular lung water from overzealous fluid resuscitation is challenging and requires vigilance with invasive monitoring. The use of hormonal resuscitation remains controversial with studies showing mixed results. Donor management is analogous to managing six to eight critically ill patients simultaneously; this period can impact the quality of the organ, the quality of life of the recipient and should be undertaken with the same level of intensity that is applied to any other critically ill patient.