There is a major gap between supply and demand of organs for transplantation. Organ donation after neurological death is increasing in the United States, and there is potential for this gap to be minimized by focused medical management of the potential donor in the ICU. Increasing organ yield requires early potential donor identification and early referral to organ procurement organizations, and understanding the medical issues specific to the brain-dead patient, such as hemodynamic instability requiring vasopressors, coagulopathy, diabetes insipidus, renal failure, and acute lung injury/acute respiratory distress syndrome. Intensive care with treatment focused on these issues has the potential to increase both the number of potential donors and the number of organs transplanted per donor.
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