Show Summary Details
Page of

Critical care of the organ donor 

Critical care of the organ donor
Critical care of the organ donor

Matthew B. Bloom

, Ali Salim

, and Darren J. Malinoski

Page of

PRINTED FROM OXFORD MEDICINE ONLINE ( © Oxford University Press, 2016. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 22 October 2019

Marked physiological changes accompany the transition to neurological death as different portions of the brain become injured during the herniation process. These dramatic changes present a multifaceted challenge to the treating intensivist. Brainstem ischaemia causes a catecholamine surge as the medulla seeks to maintain cerebral perfusion pressure and improve local tissue oxygenation. This is followed by a loss of sympathetic activity causing profound vasodilatation, myocardial depression, and low levels of serum catecholamines. The SIRS seen in neurological death takes a toll upon the pulmonary system of potential donors, resulting in utilization rates of potential lungs of only around 20%. Sympathetic storm and subsequent cardiovascular collapse have a deleterious effect upon the renal system. Ischaemia of the hypothalamic–pituitary axis can lead to diminished circulating levels of adrenocorticotropic hormone, thyroid-stimulating hormone, and vasopressin, resulting in important endocrine derangements with marked systemic effects. Hypothermia and acidosis, along with the dilution of clotting factors, fibrinogen, and platelets, can contribute to a state of disseminated intravascular coagulation and uncontrollable bleeding. The development of donor management goals (DMGs) has created specific physiological targets for the organ procurement organization and intensivist to achieve, aimed at maximizing the total number of transplantable organs. The early and persistent attainment of DMGs is critical for maximizing the number of organs transplanted per donor.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.