Anesthesia for Organ Procurement

Organ donation and procurement are essential parts of organ transplantation. The shortage of organs available for transplantation is a worldwide problem and limits the expansion of organ transplantation. Transplant grafts can be obtained from deceased or living donors. The deceased can donate after brain death or circulatory death. The unique pathophysiology associated with each donor type has the potential to impact graft acceptability and quality. To increase the donor pool, many centers use high-risk donors, which may present additional challenges to perioperative management. Ischemia-reperfusion injury, an unavoidable process in organ transplantation, can also cause perioperative and long-term complications. Management of non-cadaveric donors starts in the intensive care unit where goal-directed management has the potential to improve the number of organs transplanted per donor and to lessen the likelihood of postoperative graft failure. New technologies, including machine perfusion after procurement, are promising ways to mitigate the effects of prolonged preservation, to increase the donor pool, and to improve transplant recipient outcomes. The anesthesiologist must possess an understanding of the physiologic alterations associated with brain and circulatory death to implement interventions that optimize the quality of donated organs and have an awareness of the ethical and legal issues related to organ donation.