Organ donation in adults: a critical care perspective



The shortage of organs for transplantation is an important medical and societal problem because transplantation is often the best therapeutic option for end-stage organ failure.


We review the potential deceased organ donation pathways in adult ICU practice, i.e. donation after brain death (DBD) and controlled donation after circulatory death (cDCD), which follows the planned withdrawal of life-sustaining treatments (WLST) and subsequent confirmation of death using cardiorespiratory criteria.


Strategies in the ICU to increase the number of organs available for transplantation are discussed. These include timely identification of the potential organ donor, optimization of the brain-dead donor by aggressive management of the physiological consequence of brain death, implementation of cDCD protocols, and the potential for ex vivo perfusion techniques.


Organ donation should be offered as a routine component of the end-of-life care plan of every patient dying in the ICU where appropriate, and intensivists are the key professional in this process.

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Correspondence to Giuseppe Citerio.

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The authors declare no conflict of interest for this manuscript.

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All the authors have contributed equally to this work.

Take-home message: The shortage of organs for transplantation is an important medical and societal problem. Strategies in the ICU can increase the number of organ available for transplantation. These include: 1. optimizing the management of donors after brain death (DBD). 2. Implementing controlled DCD (cDCD). 3. Introducing a pathway for patients with devastating brain Injury (DBI).

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Citerio, G., Cypel, M., Dobb, G.J. et al. Organ donation in adults: a critical care perspective. Intensive Care Med 42, 305–315 (2016).

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  • Organ donation
  • Brain death
  • Donation after brain death
  • Donation after circulatory death
  • Intensive care