Diagnostic management of brain death in the intensive care unit and organ donation

Some neurologic injuries are so severe that they are initially deemed non-survivable and deemed “catastrophic brain injuries.” In such cases, the goal of critical care is to maintain and hemodynamic stability and end organ perfusion. The primary reason for maintaining homeostasis is that some patients may improve and survive with optimal perfusion to the brain and correction of physiologic and metabolic abnormalities. For those patients that do not improve, brain death testing is initiated and when confirmed by local protocols, the goal shifts to preserving the option of organ donation for every patient and family that choose to pursue it. Maintaining normal hemodynamic, metabolic, and endocrine function remains important in the potential organ donor, and we will review these topics in this chapter.