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KEY POINTS

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  • Increasingly successful solid organ transplantation has increased the need for organ donors.

  • Maximizing organ procurement and expanding donor acceptance criteria should decrease the organ shortage.

  • Aggressive ongoing critical care of the multiorgan donor is essential to improve organ retrieval and posttransplant graft performance.

  • Understanding the process of brain death is essential for directing donor treatment strategies to ensure preservation and function of donor organs.

  • The goals of management of the multiorgan donor are to maximize organ function by maintaining organ perfusion and oxygenation, and to promptly recognize and treat potential complications such as hypotension, dysrhythmia, pulmonary edema, massive diuresis, coagulopathy, hypothermia, and sepsis.

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Organ transplantation has evolved rapidly from the first early successes to the current widespread use of donated organs for the treatment of end-stage kidney, liver, heart, and lung failure.1 The success of solid organ transplantation has increased the need for an expanded supply of organ donors. In response to this need, the age limit for deceased donors has been increased, and donors over the age of 65 years are frequently successfully utilized.2 The use of organs from living-related donors, living-unrelated donors, and non–heart-beating donors (ie, donation after cardiac death [DCD]) has also increased.3 Nevertheless, there has been a progressively widening gap between the number of patients waiting for transplants and the number of transplantations performed. According to the United States Organ Procurement and Transplantation Network (OPTN) as of December 31, 2010, the number of patient registrations was 100,597 with the majority of patients in the 18 to 64 year age range. In 2008, there were 14,203 donors available (deceased = 7984, living = 6219) and a total of 27,961 transplants were performed in the United States.4 In cadaveric donors, the largest increase has been in donors older than 50 years of age for last 10 years (170%). One consequence of the increased proportion of older and more diverse donors has been the increase in organs discarded after being procured.3

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The relevance of a properly functioning transplanted organ cannot be overemphasized and it is clearly crucial for the success of transplantation of organs requiring immediate function such as the heart and lung. Acute lung allograft dysfunction is the leading cause of death within 30 days of lung transplantation.5 Temporary failure of the liver, kidneys, and pancreas may be tolerated with supportive measures such as hemodialysis and pharmacologic interventions.

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At a time when transplant surgeons are facing an increasing number of deaths on the waiting list, and as the size of the list continues to grow, there has never been a greater drive to utilize a higher percentage of older or otherwise extended donors, minimize the incidence of primary graft dysfunction, and develop organ donor management strategies that continue to increase the number of organs available for transplant.6-9

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To increase the number of transplantable organs, UNOS created the Critical Pathway for ...

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