Organ Procurement, Preservation, and Donor Management
Core concepts
Learn donor types (brain death, circulatory death, living) and the physiologic consequences of brain death: autonomic storm, diabetes insipidus, hypothermia, and coagulopathy. Understand donor management goals for hemodynamics, oxygenation, urine output, and hormonal replacement, and how these protect organ function. Know preservation solutions (University of Wisconsin, histidine-tryptophan-ketoglutarate, and others), static cold storage versus machine perfusion, and safe cold ischemia times by organ. Understand procurement technique, the sequence of organ removal, and warm ischemia in donation after circulatory death. Know donor infection and malignancy transmission risk and the role of donor-derived disease screening.
Traps
Questions test whether you treat the donor as a patient: fixing hypotension with fluids and vasopressors before hormones, and recognizing diabetes insipidus rather than giving diuretics. Another trap is assuming longer cold ischemia is uniformly safe; kidneys tolerate more than hearts and lungs. Distinguish donation after brain death from donation after circulatory death withdrawal timing, and remember that machine perfusion is a preservation strategy, not a viability guarantee.
Worked example
A brain-dead donor with polyuria, high serum sodium, and low urine specific gravity. Rule of thumb: suspect diabetes insipidus; replace with vasopressin or desmopressin plus free water and monitor sodium, rather than escalating crystalloid alone.
Study strategy
Memorize acceptable cold ischemia ranges per organ and the four pillars of brain-death donor management.