Management of Extended Criteria Donors

  • Norihide Fukushima


Only about 20 % of brain-dead donors in Japan have been fitted in a so-called standard criteria donor for all organs including the heart, lung, liver, pancreas, and kidney. Therefore, it is very important for us to maximize the number of transplantable organs in order to resolve severe donor shortage in Japan [1]. From these aspects, the purposes of donor management are not only to stabilize donor’s hemodynamics until organ procurement surgery but also to maximize donor organ availability and to improve function of extended criteria donor organs. If organ availability is increased, more patients can be saved by organ transplantation. Maximizing donor organ availability is also the last wish of donors and donor families. However, if a transplant recipient died due to a very marginal donor organ, the donor family feels the loss of their loved one again. Therefore, the prevention of primary graft dysfunction (PGD) is essential for the donor family as well as for recipients.

Full - scale donor management begins after the patient is pronounced brain dead and his or her family agrees to donate the organ(s), especially in Japan. In general, donor management is based on the treatment of cardiac and respiratory dysfunction resulting in the improvement of hemodynamics, oxygen supply, and finally other organ function. The targets of hemodynamic parameters are systemic blood pressure >90 mmHg, central venous pressure (CVP) of 6–10 mmHg, urine output of 100 mL/h (0.5–3 mL/kg/h), and heart rate of 80–120 beats/min. As organ procurement surgery begins within 12 h after full-scale donor management is started, it is very different from the usual intensive care to stabilize hemodynamics and to maintain and improve organ function as much as possible in a short period. Moreover, it is important for the physicians who perform donor management to recognize the pathophysiology of brain death from the beginning to completion period.


Central Venous Pressure Brain Death Diabetes Insipidus Pulmonary Capillary Wedge Pressure Systemic Blood Pressure 
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Copyright information

© Springer Japan 2014

Authors and Affiliations

  1. 1.Department of Therapeutics for End-Stage Organ DysfunctionOsaka University Graduate School of MedicineSuitaJapan

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