Management after brain death/death by neurologic criteria for organ donation

Abstract

When organ donation is considered in a clinically brain-dead patient, it is necessary to establish Brain Death/Death by Neurological Criteria (BD/DNC) and continue intensive somatic support to preserve organs for transplantation. Although most management strategies in organ donors are similar to those for critically ill patients, specific pathophysiological changes observed in organ donors include catecholamine surge, neurological lung edema prior to and after BD/DNC, and endocrine complications, such as diabetes insipidus. We summarize the world-consensus statement about brain death and death by neurologic criteria established in 2020 and the current Japanese recommendations and management strategies for five areas, namely, mechanical ventilator settings, catecholamine selection and dosing strategy, choice of antibiotics, management of electrolyte imbalance, and nutrition.