THE PHYSIOLOGICAL-CHANGES ASSOCIATED WITH BRAIN-DEATH - CURRENT CONCEPTS AND IMPLICATIONS FOR TREATMENT OF THE BRAIN-DEAD ORGAN DONOR

The profound physiological disturbances associated with severe intrace rebral pathology have long been recognized. These changes have also be en described in the brain dead potential organ donor but have only bee n studied since the early 1980s. Physiological disturbances in the bra in dead organ donor result in a diffuse vascular regulatory injury and a diffuse metabolic cellular injury. The net result of these changes is an inexorable deterioration of all organs and eventual ''cardiovasc ular death'' of the patient. This paper reviews these physiological ch anges and the effect they may have on solid transplantable tissues, an d discusses the management of brain dead organ donor with regard to th ese changes. Current concepts of brain death and how they may affect t he interpretation of the observed physiological changes are also revie wed.