title: Organ donation in adults: a critical care perspective.
abstract: OBJECTIVE
  The shortage of organs for transplantation is an important medical and societal problem because transplantation is often the best therapeutic option for end-stage organ failure.
  
  
  METHODS
  We review the potential deceased organ donation pathways in adult ICU practice, i.e. donation after brain death (DBD) and controlled donation after circulatory death (cDCD), which follows the planned withdrawal of life-sustaining treatments (WLST) and subsequent confirmation of death using cardiorespiratory criteria.
  
  
  RESULTS
  Strategies in the ICU to increase the number of organs available for transplantation are discussed. These include timely identification of the potential organ donor, optimization of the brain-dead donor by aggressive management of the physiological consequence of brain death, implementation of cDCD protocols, and the potential for ex vivo perfusion techniques.
  
  
  CONCLUSIONS
  Organ donation should be offered as a routine component of the end-of-life care plan of every patient dying in the ICU where appropriate, and intensivists are the key professional in this process.
authors.affiliation: School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy. giuseppe.citerio@unimib.it.|Neurointensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy. giuseppe.citerio@unimib.it.
authors.forename: Giuseppe
authors.identifier: http://orcid.org/0000-0002-5374-3161
authors.initials: G
authors.lastname: Citerio
authors.affiliation: Division of Thoracic Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cypel
authors.affiliation: Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia.|School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
authors.forename: Geoff J
authors.initials: GJ
authors.lastname: Dobb
authors.affiliation: Organización Nacional de Trasplantes, C/Sinesio Delgado 6, Pabellón 3, 28029, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Dominguez-Gil
authors.affiliation: Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Frontera
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Greer
authors.affiliation: The Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
authors.forename: Alex R
authors.initials: AR
authors.lastname: Manara
authors.affiliation: Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Sam D
authors.initials: SD
authors.lastname: Shemie
authors.affiliation: Department of Neurocritical Care, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK.|National Institute for Health Research UCLH Biomedical Research Centre, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Smith
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Valenza
authors.affiliation: Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Eelco F M
authors.initials: EFM
authors.lastname: Wijdicks
mesh_terms: D000328:Adult; D001926:Brain Death; D006323:Heart Arrest; D006801:Humans; D007362:Intensive Care Units; D009927:Tissue and Organ Procurement; D028761:Withholding Treatment
keywords: Brain death; Donation after brain death; Donation after circulatory death; Intensive care; Organ donation