BJA Education, 21(5): 194e200 (2021)

doi: 10.1016/j.bjae.2021.01.001
Advance Access Publication Date: 3 March 2021

Matrix codes: 1A01;

2A03; 3C00

Perioperative management of the organ donor after

diagnosis of death using neurological criteria
S. Corbett1, D. Trainor2 and A. Gaffney1,*
1
Beaumont Hospital, Dublin, Ireland and 2Royal Victoria Hospital, Belfast, UK
*Corresponding author: alangaffney@beaumont.ie

Keywords: anaesthesia; brain death; tissue and organ procurement

Learning objectives Key points

By reading this article you should be able to:

Specify the adverse effects on organs after the
diagnosis of death using neurological criteria.

Describe the management of the donor’s physi-
ology to optimise the quality of organs donated.

Outline the retrieval process and procedure, and
the associated anaesthesia interventions
required at each stage.
Diagnosis of death using neurological criteria (DNC), previ-
ously termed brain death or brainstem death, is a clinical
diagnosis. A diagnosis of DNC is made when severe, irre-
versible, structural brain injury leads to irreversible loss of
both the capacity to breathe and the capacity for conscious-
ness.1 Each year, organs are retrieved for transplantation from
approximately 1600 deceased organ donors in the UK and 80
deceased organ donors in the Republic of Ireland (ROI).2,3 Sixty
percent of deceased organ donations in the UK take place after
death has been diagnosed by neurological criteria and 40%
after death has been diagnosed by circulatory criteria.2 In this
article, we describe the perioperative management of the or-
gan donor following DNC in the UK and ROI.
Sarah Corbett FCAI EDIC is a specialist trainee in anaesthesiology at
Beaumont Hospital in Dublin.

Communication between the anaesthetist and
the retrieval team is key to a successful retrieval
operation.

The medical management of the deceased organ
donor that began in ICU should continue through
the retrieval process.

The aim of medical management is to optimise
the quality of transplantable organs.

The donor is dead and so drugs are given to
attenuate physiological responses, not to provide
‘anaesthesia’.
Personnel and their roles
Intensive care
The anaesthetist is one member of a large team of pro-
fessionals that facilitates the donation, retrieval and trans-
plantation of organs. Patients are admitted to the ICU, often
for a number of days before the diagnosis of death. Intensiv-
ists, intensive care nurses, physicians, surgeons and support
staff care for the patient and ensure that the family is
informed and supported at all stages. The intensive care team
is responsible for the medical management of the patient up
until the point at which death is declared. Once death has
been declared the intensive care team turns their focus to the
medical management of the potential organ donor.

Dominic Trainor BSc MRCP FCARCSI DICM is a consultant anaes-
thetist and intensivist, and clinical lead for organ donation at the
Royal Victoria Hospital, Belfast.
Alan Gaffney MRCPI FCAI DICM PhD is a consultant anaesthetist
and intensivist, and clinical lead for organ donation at Beaumont
Hospital, Dublin.
Specialist nurse-organ donation
The specialist nurse-organ donation (SNOD) is the local
coordinator of the donation and retrieval process in the UK.
The National Institute for Health and Care Excellence de-
scribes the criteria for referral of patients who have suffered a

Accepted: 3 January 2021

© 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
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194

catastrophic brain injury to the SNOD.4 These include the
absence of one or more cranial nerve reflexes, a Glasgow
Coma Score of 4 or less, or a clinical decision to perform
brainstem testing.
The SNOD can ascertain whether the patient has made his
or her wishes regarding organ donation known by referring to
the NHS Organ Donor Register. This is a national register
where a person can record their decision to donate or not to
donate organs after death. The register is managed by NHS
Blood and Transplant (NHSBT), which oversees organ dona-
tion and transplantation in the UK.2
In ROI the SNOD role is split into a centralised retrieval
component (National Organ Procurement Service) and a local
ICU-based coordination component (organ donation nurse
managers [ODNM]).5 Organ Donation and Transplantation
Ireland (ODTI) oversees organ donation in ROI.
A collaborative approach involving the consultant ICU
physician, bedside nurse and SNOD or ODNM ensures that the
family understands the diagnosis of death. The family will
interact with many staff, but discussions regarding the diag-
nosis of death are usually limited to a small number of clini-
cians familiar with the patient. Only when the family
understands and accepts that death has taken place is a dis-
cussion regarding organ donation introduced as a routine part
of end-of-life care. The SNOD has specific expertise and
training in approaching family members for assent to organ
donation.
Anaesthetist
The anaesthetist continues the medical management of the
deceased organ donor from transfer out of the ICU through the
retrieval procedure. The anaesthetist facilitates the retrieval
team’s assessment and retrieval of donor organs while
maintaining physiological homeostasis throughout. The
anaesthetist also contributes to ensuring a calm and
respectful atmosphere during transfer to the operating
theatre and during the retrieval operation. The respectful
ambience acknowledges the impact that the process of organ
donation and retrieval has on family members, clinical and
non-clinical hospital staff.
National Organ Retrieval Service
A team of retrieval surgeons and nurses from the National
Organ Retrieval Service (NORS) arrives before the retrieval
procedure to meet with local staff and to prepare the oper-
ating theatre.6 In the UK there are six thoracic organ retrieval
teams and 10 abdominal organ retrieval teams, of which three
thoracic and seven abdominal teams are on call at any one
time. The teams that attend are assigned to each hospital in
the UK based on travel time and even distribution of workload
and are the only teams authorised to perform retrieval oper-
ations in most situations.6,7 In ROI the retrieval teams are
mobilised from the three national transplant centres.
Diagnosis of DNC
Death can be diagnosed by somatic, circulatory and neuro-
logical criteria.8 Regardless of how death is diagnosed, death
has occurred when there is irreversible loss of both the ca-
pacity for consciousness and the ability to breathe. A recent
international consensus statement recommends a definition
of DNC as ‘the complete and permanent loss of brain function
Perioperative management of the organ donor
as defined by an unresponsive coma with loss of capacity for
consciousness, brainstem reflexes and the ability to breathe
independently’.9
Although different countries have varying definitions of
DNC, the clinical diagnostic tests are similar.10,11 First is an
assessment of brainstem reflex function through examination
of the cranial nerves. Second is an apnoea test. Some coun-
tries may require ancillary tests, such as a four-vessel cerebral
angiogram in addition to clinical tests.
In the UK and ROI, the diagnosis of DNC requires a number
of preconditions to be met before clinical brainstem tests can
be relied upon to confirm death. These preconditions include
diagnostic certainty of irreversible structural brain injury with
known aetiology and the absence of confounders that may
mimic irreversible apnoea and coma.1 Confounders include
depressant drugs, hypothermia, or certain reversible circula-
tory, metabolic, or endocrine disturbances.1 Sometimes,
ancillary tests are necessary to inform the clinical diagnosis of
death.8 Examples include where the preconditions cannot be
fully met or where all cranial nerves cannot be reliably tested,
such as in cases of high cervical injury or facial trauma.
Brainstem tests are performed on two separate occasions
by two doctors who are familiar with the testing procedure.
Both doctors must be fully registered with the General Medical
Council (in the UK) or the Medical Council (in ROI) for 5 yrs. At
least one of the two doctors must be a consultant.1,8 No time
interval is specified between the two sets of tests, only that the
patient must have completely recovered after the first apnoea
test. The time of death is the time of completion of the first set
of tests in the UK. In the ROI the time of death is the time of
completion of the second set of tests.
Process from the diagnosis of death to
transfer to the operating theatre
The process of organ donation and transplantation is com-
plex. Multiple factors affect the time from the diagnosis of
death to organ retrieval. It is important that the anaesthetist is
aware of those factors in order to plan the timing of the
retrieval operation within the confines of limited operating
theatre resources, and to prioritise other elective, urgent and
emergency surgeries.
Organ retrieval is timed to afford the best possible organ
quality at the time of retrieval and to minimise the time be-
tween retrieval and transplantation (see below). At the same
time, every effort is made to minimise the risk of transmitting
infection or cancer from the donor to the recipient by
assessing the clinical history, examination and investigations.
Donor and recipient matching
Tests for immunological matching are carried out to reduce
the risk of organ rejection in the recipient.12 This process be-
gins when potentially transplantable organs are offered to
recipient centres. The proportion of this process that must take
place before the retrieval operation depends on the organs to
be transplanted and the timeframe in which transplantation
needs to occur after organ retrieval. Cold ischaemia time refers
to the interval between starting cold perfusion of the organs in
the donor’s body after the circulation has ceased until normal
blood perfusion in the recipient is restored. Organs are kept
cool to reduce metabolic demand. Organs that only tolerate
short cold ischaemia times require more of the immunological
testing and matching process to take place before organ
BJA Education - Volume 21, Number 5, 2021 195
Perioperative management of the organ donor
retrieval, because the transplant operation must take place
soon after retrieval. This is especially the case for heart and
lung transplantation. A suitably matched heart recipient un-
dergoes surgery in the recipient’s hospital simultaneously to
the retrieval operation in the donor hospital, because the cold
ischaemia time for a transplanted heart is approximately 4e6
h. The kidney, liver, pancreas and bowel tolerate longer cold
ischaemia times and so the time between retrieval and
transplantation can be longer. Less of the immunological
testing and matching process needs to be completed before the
retrieval operation starts. Therefore the specific organ(s) to be
retrieved affect the timing of the retrieval surgery.
Time from death to organ retrieval
The mean time taken from initial donor referral to the begin-
ning of the retrieval operation increased from 20 h in 2011e2 to
39 h in 2017e8 according to NHSBT audit data.13 Delays in the
donation process have resulted in a small number of families
deciding not to proceed with organ donation.
Preoperative assessment
Before the retrieval operation, the anaesthetist attends the ICU
to receive a detailed handover before transferring the organ
donor to the operating theatre. Handover should include de-
tails of the event leading to the catastrophic brain injury, the
method of diagnosing death and confirmation of family assent
to organ donation. The results of all investigations should be
reviewed and an organ-specific assessment should be per-
formed. The anaesthetist should be familiar with the organs to
be transplanted, medical management to date and the plan for
ongoing medical management.
The circumstances of death of neurologically injured pa-
tients often require the coroner or procurator fiscal to be
informed and to consent to organ donation.14 The coroner
may place certain restrictions on which organs may be
donated.
Timing of the retrieval operation
The operating theatre starting time is agreed between the
SNOD, the ICU team, the donor operating theatre supervisor
and the anaesthesia team. The wishes and requests of family
members and the needs of the ICU staff, operating room staff
and the NORS team are all taken into consideration when
deciding upon an agreed starting time.
Medical management of the organ donor
The aim of medical management of the organ donor is to opti-
mise the quality of donated organ(s), thereby increasing the
likelihood of a successful outcome for the transplant recipients.
The pathophysiology of neurological death has been well
described.15 Autonomic, metabolic and endocrine distur-
bances associated with brainstem infarction and the process
of dying have effects on multiple systems.16 Attentive man-
agement of the potential organ donor can attenuate or even
reverse these effects, though any particular management
strategy that improves the function of one organ may worsen
the function of another.17 It is important that the anaesthetist
196 BJA Education - Volume 21, Number 5, 2021
is aware of which organs are planned for organ trans-
plantation. The medical management of those organs plan-
ned for transplantation should be prioritised over those not
planned for transplantation. The medical management of
those organs planned for transplantation should balance the
physiological requirement of each organ.
Medical management of the organ donor begins in the ICU
once death has been diagnosed and continues right through
the retrieval surgery to the point of organ removal. Active
management of the organ donor has been shown to increase
the number of organs suitable for transplantation.18 The
anaesthetist is responsible for continuing the medical man-
agement strategy started in the ICU through the trans-
portation and operative phases (Table 1).19e21
Specific aspects of management
Several aspects of management are specific to patients in
whom death has been diagnosed using neurological criteria.
Catecholamine ‘surge’
Brainstem herniation is associated with a surge in circulating
catecholamines that can cause myocardial damage and car-
diac dysfunction.15,20,22 Cardiac retrieval may need to be
delayed and the heart monitored for improvement when
function is initially impaired but the heart is structurally
normal.21,23 Vasopressin should be considered the first-line
drug treatment for hypotension caused by vasodilatory
shock (see below).
Fluids
Where intravascular resuscitation is necessary, isotonic
crystalloids such as Hartmann’s solution or 0.9% saline are
preferred.21 Colloid solutions can also be used but starches are
generally avoided as these have been associated with worse
graft outcomes.16 There is no contraindication to transfusing
blood or blood products where necessary.
Lung-protective ventilation
Lung-protective ventilation is standard of care in the ICU and
should be continued throughout the transport and retrieval
phases.20 Maintaining tidal volumes of 6e8 ml kg1 ideal body
weight, plateau inspiratory pressures <30 cmH2O and PEEP
titrated to FIO2 may lead to an increase in the number of donor
lungs being transplanted.24
Diabetes insipidus
Central diabetes insipidus is a common complication of se-
vere neurological injury.21 Decreased circulating antidiuretic
hormone concentrations cause the kidneys to excrete large
volumes of dilute urine.20 Untreated, this can cause hyper-
osmolar hypernatraemia and hypovolaemia with reduced
organ perfusion. A urine output >4 ml h1 should alert the
anaesthetist to this possibility. Treatment comprises hypo-
tonic fluids i.v. to replace water losses and an infusion of
vasopressin (especially where concurrent vasopressor ther-
apy is required) or s.c. desmopressin if necessary (Table 1).
Hormone replacement
A number of hormone replacement therapies including
vasopressin, glucocorticoids, thyroid hormone and insulin

Table 1 Summary of the management of the potential organ donor.21
may also be given.20 Although the level of evidence is low that
hormone replacement increases the number of transplant-
able donor organs, these therapies appear to be safe.21
Hypothermia
Hypothermia is common, because thermoregulatory control
from the hypothalamus is lost. Active heating measures are
often needed to maintain normothermia.21,25 Although some
data support using moderate hypothermia to decrease delayed
graft function after renal transplant, there are few data to
support the general use of intraoperative hypothermia.26
Transfer to the operating theatre
Transfer to the operating theatre is the same as for any other
patient receiving artificial ventilation and leaving the ICU for a
procedure. The donor can usually be transferred on a trans-
port ventilator or with a C-circuit. In donors with hypoxic
respiratory failure, the mode of ventilation must not lead to
worsening hypoxia with resultant damage to potentially
transplantable organs. Spinal reflexes are common after DNC
(see below). The anaesthetist may consider giving a neuro-
muscular blocking agent before transfer.
Family members may wish to say a final goodbye to their
deceased loved one just before leaving the ICU for the oper-
ating room and this should be facilitated wherever possible.
Perioperative management of the organ donor
The retrieval operation
Communication
The operating theatre may look and feel different to usual. It is
likely that the anaesthetist will be working with unfamiliar
staff over the next number of hours. It is a good idea to meet
with the SNOD and the NORS team and to make introductions
before transporting the donor from the ICU as this facilitates
good communication between teams. The retrieval surgeons
may need to make decisions about the suitability of an organ
for transplantation because this has consequences for po-
tential recipients. In addition, there are often technical
anatomical challenges to removing organs. Good communi-
cation enhances the likelihood of a successful outcome.
Haemodynamic disturbances are common during retrieval
surgery, so the anaesthetist and retrieval team need to be able
to anticipate, discuss and manage these events before and as
they occur.
Spinal reflexes
Both motor and autonomic spinal reflexes and reflex arcs
remain intact after DNC. These reflexes include movement of
the trunk, limbs and neck. They may be more pronounced
because of loss of descending inhibitory input from the brain.
Noxious and non-noxious stimuli may provoke both motor
BJA Education - Volume 21, Number 5, 2021 197
Perioperative management of the organ donor
Fig 1 Schematic representation of the aortic cross-clamp and perfusion
catheters in situ in the organ donor after laparotomy and sternotomy.
Figure adapted with permission from Wunderlich et al. Commission of
Organ Donation and Removal German Transplantation Society. DTG pro-
curement guidelines in heart beating donors. Transpl Int. 2011
Jul;24(7):733-57.
and autonomic responses in up to 50% of DNC cases.6 These
responses may need to be moderated by the anaesthetist
during the retrieval procedure.16,19 Spinal reflexes can also be
upsetting to those who may not understand their basis or
significance. For this reason, neuromuscular blocking drugs
may be given during transfer to the operating theatre to avoid
unwanted reflexes and unnecessary concern among staff.
Neuromuscular blockade is also used to prevent reflex motor
activity throughout the retrieval operation.16,20
Volatile anaesthetics can reduce the autonomic spinal re-
flex arc that causes hypertension and tachycardia in response
to a surgical stimulus. Volatile anaesthetics may also
contribute to ischaemic preconditioning and improve graft
function in the recipient.19,20 Volatile anaesthetics are not
given to provide ‘anaesthesia’ as the donor is dead.
Monitoring
All donors should have intra-arterial, central venous and
urinary catheters placed whilst in the ICU.16 Invasive arterial
BP, arterial oxygen saturation, ECG and temperature should be
monitored from the ICU to the operating theatre. At least one
large bore peripheral i.v cannula should be inserted to facili-
tate large volumes of fluids if necessary.
For cardiac retrieval, a second transducer system should be
prepared to monitor CVP and, when required, intracardiac
pressures during cardiac assessment. The cardiothoracic
surgeon will commonly attach sterile monitoring tubing to a
needle and pass the end to the anaesthetist who, in turn, at-
taches it to the transducer, flushes the tubing, zeroes it to
198 BJA Education - Volume 21, Number 5, 2021
atmospheric pressure and displays the pressure waveform on
the anaesthesia monitor. A pulmonary artery catheter may
have been placed in the ICU and can be used to assess right-
sided cardiac pressures and cardiac output.
Inspired oxygen (FIO2) and end-tidal carbon dioxide (PE0 CO2)
should be monitored. End-tidal inhalation agent concentra-
tions should also be measured when volatile agents are used.
Airway pressures and tidal volumes should be measured to
ensure lung-protective ventilation where lung retrieval is
planned.
Arterial blood gas analysis can be helpful to monitor tissue
perfusion (lactate concentration), oxygenation, ventilation
(PaCO2), electrolytes and blood glucose concentrations during
the procedure.
General considerations
As with any major operation, large fluid shifts and haemo-
dynamic changes may occur and the anaesthetist should be
prepared. Cardiac arrhythmias are not infrequent in the DNC
donor and should be anticipated and managed in the usual
way (electrolyte replacement, antiarrhythmic drugs, internal
DC cardioversion and organ-preserving cardiopulmonary
resuscitation if necessary).27 I.V. infusion pumps and rapid
fluid infusers should be available and the anaesthetist should
be familiar with their use. The availability of blood products
should be confirmed before the start of surgery.
It is important to note that there are times when parts of
the procedure may be delayed or prolonged. Reasons include
the unexpected finding of suspicious lesions after inspection
of the organs that may need to be biopsied and reviewed
before proceeding with procurement.6 In the case of heart
transplantation, the preimplantation phase of the recipient
operation may be complex. For example, the recipient may
have had previous surgeries making dissection difficult.
Donor aortic cross-clamping may need to be delayed (see
below) to reduce the risk of a prolonged cold ischaemia time of
the donor heart if the recipient is not ready for immediate
transplantation. Such unanticipated delays are all part of the
donation process.
Procedure common to any organ retrieval
The donor is positioned supine usually with the arms by the
sides. Because the length of the incision makes placement of a
forced air warmer difficult, a warming device may be placed
underneath the patient. Antibiotics and steroids (if not
already receiving as part of hormone replacement therapy)
are given as per advice from the NORS team or SNOD. A
neuromuscular blocking agent is given to optimise operating
conditions. Many centres will observe a moment of silence or
a senior member of staff will say a few words of thanks to
acknowledge the donor’s gift before the start of the
operation.6
A laparotomy and sternotomy are performed (Fig. 1).15 Any
associated spinally-mediated hypertension, tachycardia, or
both can be managed using volatile agents or opioids.20 After a
period of preoxygenation, the ventilator tubing is discon-
nected from the tracheal tube during sternotomy to avoid
damage to the underlying lungs from the sternotomy saw.6
The surgeons begin with a thorough visual inspection of the
organs for previously undiagnosed disease, particularly ma-
lignancy.28 The initial dissection of each organ focuses on
preparing for the rapid ligation of blood vessels should severe

haemodynamic instability or cardiac arrest necessitate im-
mediate organ retrieval.25 Once adequate dissection has taken
place, heparin is given (300 IU kg1 i.v.) and the thoracic aorta,
abdominal aorta or both are cannulated (Fig. 1). Significant
blood loss may occur at this stage.
The organs are removed in the following order: heart,
lungs, liver, small bowel, pancreas, kidneys.19 The order of
removal is related to the cold ischaemia tolerance of each
organ. Lymph nodes and sections of the spleen are taken and
accompany each organ for immunological testing.25
Procedure specific to the retrieval of abdominal organs
The aorta is cross-clamped and the aortic cannulae are
flushed with cold perfusate (Fig. 1). At the same time, the
venous outflow vessels are divided and the perfusate con-
tinues to flow until the venous outflow runs clear. The heart
ceases to beat. Suction catheters ensure that blood and
perfusate are immediately removed from the venous side of
the circulation and are not allowed to pool within the thoracic
or abdominal cavities. The organs are bathed in ice slush as an
external aid to organ cooling.6
The liver has multiple ligamentous attachments that must
be divided to facilitate mobilisation and inspection.28 If the
liver is being divided for transplantation into two recipients,
dissection may be prolonged. The small and large bowel must
also be mobilised in order to identify the great vessels in the
retroperitoneum.19 The liver has a dual blood supply, so the
inferior mesenteric vein may also be cannulated allowing the
portal circulation to be flushed with cold perfusate.28 If the
pancreas is to be retrieved, a nasogastric tube and clamp are
placed for antimicrobial decontamination of the small bowel
with povidone-iodine (Betadine) solution, as the pancreas is
removed with a cuff of duodenum.19 Cold preservation solu-
tion is given through a cannula in the abdominal aorta, and
the perfusate is vented through the divided inferior vena cava.
Procedure specific to thoracic organs retrieval
For cardiac retrieval, the heart is inspected and palpated for
coronary artery calcification. This may cause brief but signif-
icant haemodynamic instability.19 A transoesophageal echo-
cardiogram may be performed to assist with cardiac
assessment if this was not done before surgery. Intracardiac
pressures may be measured as described in the monitoring
section above. The superior vena cava may be ligated or
clamped high in the chest, which may require the withdrawal
of any indwelling central venous pulmonary artery catheter.16
The aortic root is cannulated before cross-clamping and car-
dioplegia is given.19 Both sides of the heart are vented to avoid
overdistension of the ventricles with cold perfusate or car-
dioplegia (usually the right side via the inferior vena cava and
the left side via the left atrium or the left atrial appendage).
The left atrium is excised with an adequate cuff for
reimplantation.
If the lungs are to be retrieved, a catheter mount with a
bronchoscope port is attached to the tracheal tube so that the
surgeon can assess the lungs for anatomical variations,
intraluminal disease or infection using bronchoscopy.27,29
After the pleura have been opened a gentle recruitment
manoeuvre may be required to visually assess compliance of
the lungs and the ventilator disconnected at full inspiration to
Perioperative management of the organ donor
assess their elastic recoil.27,29 Regional gas exchange may be
assessed from serial arterial blood gas samples drawn directly
from each of the four pulmonary veins with the fraction of
inspired oxygen (FIO2) set at 1.0.27 The diaphragm may be
opened during the dissection. This changes lung compliance:
pressure control modes of ventilation should be used with
care because the lungs can be easily overinflated. The pul-
monary artery is cannulated. A pulmonary vasodilator such as
a prostaglandin may be given directly into the pulmonary
artery before cross-clamping.19,29 This can cause profound
hypotension. The pulmonary artery is perfused with cold
preservation solution. Mechanical ventilation continues dur-
ing lung perfusion.29
Immediately before lung removal the anaesthetist may be
required to inflate the lungs gently with FIO2 0.5 to an airway
pressure of 15e20 cmH20. This is to confirm visually that all
atelectatic areas have been re-expanded before withdrawal of
the tracheal tube and stapling of the trachea.16
Debriefing
The debrief is an important part of the organ donation and
retrieval process.21 The process is often unfamiliar to oper-
ating theatre staff including non-clinical staff such as porters
and cleaners. It is important, at some stage after the donation
process, to sit down with those involved and talk through the
process, answer questions, facilitate discussion and to offer
support to those who need it. NHSBT and ODTI will send a
letter to staff in donating hospitals thanking them for their
efforts and providing some details on patients who benefited
from the donated organs.
Conclusion
The anaesthetist has an important role in ensuring successful
retrieval and transplantation of donated organs from patients
where death is declared using neurological criteria. By un-
derstanding the organ donation and retrieval process and the
roles played by so many people, the anaesthetist can safely
manage the transfer of the organ donor to the operating
theatre. He or she can continue the medical management of
the organ donor that began in the ICU, and can ensure the
physiologic optimisation, assessment and retrieval of trans-
plantable organs. Ultimately, the anaesthetist can help carry
out the wishes of organ donors and their families to give life to
others through the gift of organ donation.
The recognition that ICU management can influence the
number of transplantable organs has led to the intensive care
training bodies in both the UK and ROI including organ
donation training as part of core ICU training.30 Less is un-
derstood about how intraoperative management may affect
either the number or quality of donated organs. This is an area
of focus for future research.19,20
Acknowledgements
The authors wish to acknowledge the contribution of Davin
Gaffney for drawing Figure 1.
Declaration of interests
The authors declare that they have no conflicts of interest.
BJA Education - Volume 21, Number 5, 2021 199
Perioperative management of the organ donor
MCQs
The associated MCQs (to support CME/CPD activity) will be
accessible at www.bjaed.org/cme/home by subscribers to BJA
Education.
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