Critical Care Management of the Potential Organ Donor

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Organ donation and transplant rates vary widely across the globe, with the gap between requirements and available organs continuing to be a significant problem in many countries.1–3 This ongoing shortage has driven the creation of numerous initiatives to educate the public of the need for organ donation and to attempt to dispel urban and religious concerns over the ethics and appropriateness of organ donation.2,4 In the United States, the Revised Uniform Anatomical Gift Act requires organ procurement organizations (OPOs) and donor hospitals to have polices and guidelines in place to make sure all possible donors are appropriately evaluated and efforts are maximized to increase donation.5 As a result of these initiatives, 95% of US citizens state they “support or strongly support” organ donation, yet only 60% of eligible donors are registered donors.6 Internationally, the gap between organ supply and demand has been addressed through public outreach and education campaigns, incentives to encourage donation, enactment of presumed consent (opt-out) legislation, and other programs. Despite these nonclinical initiatives, an increased reliance on expanded or extended criteria donation (ECD), including donation after circulatory death (DCD), has been required to increase organ availability in many countries yet still falls short of the increasing demand.2 For anesthesiologists who manage the organ donor in operating rooms and intensive care units (ICUs), it is critical to implement and monitor donor management programs that support improvement in the number of organs available for transplant per donor and subsequent graft function.
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