Current and potential future trends in the management of the brain-dead organ donor

Despite advances in the prevention and treatment of end-stage organ-failure, solid-organ transplantation remains for many the best option for improving the quality of life and the likelihood of survival. Procurement of organs from brain-dead donors is the only option for the majority of patients with end-stage heart and lung failure needing and qualifying for transplantation. It has been known for quite some time, however, that the brain death process can lead to a pathophysiologic cascade that potentially produces significant donor organ dysfunction. As a result, a significant effort has been made to explore approaches to improve donor organ function by removing the organ from the brain death milieu and by protecting the organs in vivo and ex vivo from the cascade of events that is initiated during the brain death process and the inevitable and obligatory ischemia-reperfusion event. This chapter summarizes some of the exciting approaches ranging from attempts at improving the logistics of donor procurement to controlling the molecular events that lead to organ dysfunction. Thankfully, the altruism of truly generous families and donors offers hope to many.