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A protocol achieving for long-term hemodynamic stability enabled us to evaluate pancreatic endocrine function for up to 1 wk following brain death. The glucose disappearance rate was significantly lower in brain-dead patients (N = 21) than in normal controls (N = 10) (p<0.001). In 19 brain-dead patients whose plasma epinephrine concentrations exceeded 0.4 ng/ml, the mean early insulin release was significantly lower than in controls, while early insulin release was markedly higher in the remaining two patients. It is possible that early insulin released may be due to increased plasma epinephrine concentrations following brain death. Late insulin release in brain-dead patients was not lower, but was higher than controls and was accompanied by a decrease in the glucose disappearance rate. No evidence of abnormalities in histopathology of pancreas was detected at autopsy. Our results indicate that intrinsic insulin secretory function can be preserved during the first week following brain death.