Purpose of review: Current pressures of organ supply and demand require maximization of potential for organ donation. The donor population is older and has more significant comorbidity than in the past.
Optimal management of the donor after brain death (DBD) is essential to ensure that the greatest number of organs can be transplanted per donor. Defining evidence-based drugs and techniques to assist this has never been more important.
Recent findings: Care of patients with catastrophic brain injury incorporating supportive therapy targeted at specific goals and delivered by experienced specialists provides the best donation outcomes. Such pathways represent best practice critical care applied to this population. In this context, the value of some previously recommended therapies appears questionable and warrants reassessment. Prolonged (>24 h) incorporeal organ conditioning may have significant benefits.
Extracorporeal support in the resuscitation arena is emerging and, in patients who fail to respond, may yield a new source of donors.
Summary: Early identification of potential DBD, best practice critical care, and achieving defined treatment goals are associated with more transplantable organs.
Study of a complex intervention like donor management presents significant problems of organization, ethics and consent. This situation is recognized internationally and progress is being made.