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Organ Donor Issues for the Intensive Care Physician

The opportunity for organ donation most often arises in the intensive care unit following the declaration of brain death. Thus a comprehensive discussion of the topic of organ donation is of special importance to the intensive care physician. The essential criteria of brain death are provided in this review; however, a unitarian concept is emphasized, that all death is occasioned by an irreversible loss of brain function. Recovery of organs from a non-heart-beating organ donor is presented in this context. The characteristics of the suitable cadaver organ donor are reviewed, detailing donor age considerations and the exclusion criteria of HIV infection and a history of donor malignancy. An analysis of death caused by specific poisons is presented that is amenable to cadaver organ donation. The shortage of cadaver organs for transplantation persists. The major obstacle to donation is family consent. A paradigm of procedure from organ donor referral to organ recovery in the operating room is outlined, with a discussion of the suggested best practice for achieving family consent. This emphasizes the need for highly trained personnel to request consent for organ donation. Intensive care unit management of the donor following the declaration of death is given by a problem-oriented review, intended to preserve hemodynamic stability until organ recovery can be accomplished.