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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 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 recognize and treat potential complications such as hypotension, dysrhythmia, pulmonary edema, massive diuresis, coagulopathy, hypothermia, and sepsis.

  • Organs from carefully selected donors with a history of viral infection appear to be an important source to meet the increasing demands of organ transplantation.

  • Adoption of new technology such as ex vivo organ perfusion techniques and clinical innovation to assess organs and improve their quality is key to better posttransplantation outcome.


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; however, deceased donor donation rates still remain far below the estimated donor potential in North America.2,3 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.1 The use of organs from living-related donors, living-unrelated donors, and nonheart-beating donors (ie, donation after circulatory death [DCD]) has also increased.4 A recent study led by the Organ Procurement and Transplantation Network (OPTN) suggested unrealized donor potential, with the most significant unrealized potential (70%) in the 50- to 75-year-old age group and potential DCD donors.2

To increase the number of transplantable organs, the identification and referral of potential donors are key issues, particularly for DCD where early referral is critical. The two major limiting factors in organ donation today are (1) failure to identify patients that are potential organ donors and lack of referral of those patients to the organ procurement organization, and (2) refusal of patients’ families to consent to donation. A proactive donor detection program in Spain providing systematic death audits, appropriate management of mass media relations, and appropriate economic reimbursement for hospitals has resulted in the highest continuous increase by far in deceased donor organ donation within the country, reaching 35 organ donors per million population.5

Once a patient is identified as a potential organ donor, the critical pathway should be initiated by contacting the local organ procurement organization to make the referral. Organ procurement organization staff may wish to be notified as the condition of the patient deteriorates even before brain death occurs. Most often, the organ procurement organization can quickly perform ...

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