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In response to a traumatic brain injury or another tremendous physiologic ‘‘insult’’ to the brain (e.g., hemorrhagic or ischemic stroke), some patients suffer global and irreversible loss of brain stem function, leading to a diagnosis of brain death. Some of these patients may be candidates for organ and tissue donation, a decision mediated by the patient’s previously expressed wishes, sometimes in the form of an advance directive or organ donor card, and the preferences of the patient’s family [1]. Organ donation is truly a family-driven process and can be affected by various social, educational, and spiritual considerations. An organ procurement organization (OPO) representative or specially trained hospital staff member is typically responsible for communicating with family members about the process of organ donor management and the ways tissue and organ donation will benefit other patients in need. Because significant emotional issues may be involved with the loss of a loved one, educating the family and sincere sensitivity regarding their needs and wishes are crucial to the organ donation process. Organ donation also includes a complex set of medical practices. Key steps in beginning the process involve diagnosing and managing the brain dead patient, referred to in the literature as the brain dead cadaver and clinically defined as a patient who is comatose and shows no evidence of brain stem reflexes (e.g., spontaneous breathing, further defined in Table 1). These are important issues, given the ever-increasing demand for viable organs and list of individuals waiting for transplants. According to the US Organ Procurement and Tissue Transplantation Network in January 2007, nearly 100,000 people were waiting for organ transplants, with only approximately 26,000 patients receiving transplants between November 2006 and January 2007 [2]. A major issue in a hospital’s neurocritical care unit (NCU) setting is management of the brain dead cadaver, with a focus on optimizing the preservation of donor organs and the transfer of those organs to transplant candidates in other care facilities. Managing the organ donor following determination of brain death is multifaceted and involves a comprehensive system for medical care of the donor, which may include administering appropriate medications to maintain basic body and organ functions and monitoring physiologic values like oxygen, hormone, and electrolyte levels in the blood. Proper management of the organ donor is extremely important to ensure that organs are preserved and protected prior to harvesting and to optimize the number and quality of organs and tissues available for transplantation. Organ preservation prior to withdrawal of extraordinary means of support (e.g., pharmacologic support of hemodynamics, ventilator support of respiration) involves both monitoring and maintaining physiologic values within set parameters to avoid damage and maintain organ function. These parameters include blood pressure, respiratory rate, and fluid and electrolyte status. Function and levels can be maintained through administration of medications such as corticosteroids and thyroid hormones, as well as through adjustments to ventilator settings and fluid administration to maintain respiratory rate and electrolyte balance. Synchronous management of the brain dead cadaver, the patient’s family, and the members of the clinical team is crucial to ensure functioning of the implanted organ once it is transplanted. Transferring the organ from donor to recipient should be executed as quickly as possible. The wishes of family members and the actions of the care team and of the OPO representatives are important elements in managing the treatment course and process outcomes.

Organ preservation in a brain dead patient: information support for neurocritical care protocol development