title: The development and current status of Intensive Care Unit management of prospective organ donors.
abstract: BACKGROUND
  Despite continuous advances in transplant medicine, there is a persistent worldwide shortage of organs available for donation. There is a growing body of research that supports that optimal management of deceased organ donors in Intensive Care Unit can substantially increase the availability of organs for transplant and improve outcomes in transplant recipients.
  
  
  METHODS
  A systematic literature review was performed, comprising a comprehensive search of the PubMed database for relevant terms, as well as individual assessment of references included in large original investigations, and comprehensive society guidelines.
  
  
  RESULTS
  In addition to overall adherence to catastrophic brain injury guidelines, optimization of physiologic state in accordance with established donor management goals (DMGs), and establishment of system-wide processes for ensuring early referral to organ procurement organizations (OPOs), several specific critical care management strategies have been associated with improved rates and outcomes of renal transplantation from deceased donors. These include vasoactive medication selection, maintenance of euvolemia, avoidance of hydroxyethyl starch, glycemic control, targeted temperature management, and blood transfusions if indicated.
  
  
  CONCLUSIONS
  Management of deceased organ donors should focus first on maintaining adequate perfusion to all organ systems through adherence to standard critical care guidelines, early referral to OPOs, and family support. Furthermore, several specific DMGs and strategies have been recently shown to improve both the rates and outcomes of organ transplantation.
authors.affiliation: Department of Anesthesiology, Sections of Anesthesiology and Surgical Critical Care, Portland VA Medical Center, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Margaret Kathleen Menzel
authors.initials: MK
authors.lastname: Ellis
authors.affiliation: Division of Trauma, Critical Care, and Acute Care Surgery, Section of Surgical Critical Care, Portland VA Medical Center, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Mitchell Brett
authors.initials: MB
authors.lastname: Sally
authors.affiliation: Division of Trauma, Critical Care, and Acute Care Surgery, Section of Surgical Critical Care, Portland VA Medical Center, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Darren
authors.initials: D
authors.lastname: Malinoski
keywords: Critical care; donor management; kidney transplant; renal transplant