Chapter 11: Organ Donation

The chapter establishes the legal and organizational infrastructure governing organ procurement, including the Uniform Anatomical Gift Act and the National Organ Transplant Act, which established the Organ Procurement and Transplantation Network and its operator, the United Network for Organ Sharing. Critical care nurses serve as essential gatekeepers in donor identification, recognizing clinical triggers such as Glasgow Coma Scale scores below 5 or severe neurological decline that signal potential donation candidates. The determination of brain death represents a crucial clinical milestone, requiring verification of irreversible cessation of all cerebral and brainstem function through a systematic four-step process: establishing prerequisites including adequate blood pressure and core temperature, conducting comprehensive neurologic examination to document absence of brainstem reflexes, performing apnea testing to confirm absent respiratory drive, and utilizing neurodiagnostic testing when clinical findings are inconclusive. The chapter delineates multiple donor categories including living donors, brain-dead donors, and those undergoing donation after circulatory death, each with distinct protocols and considerations. Once family consent is obtained, donor management shifts emphasis from curative care to organ preservation through hormonal resuscitation with thyroid hormone and corticosteroids, hemodynamic stabilization using vasopressors and fluids, and protective ventilation strategies. For transplant recipients, the chapter addresses evaluation criteria based on organ-specific severity scores, the mechanisms and timelines of rejection types, and the necessity of lifelong immunosuppressive therapy using calcineurin inhibitors, corticosteroids, and antiproliferative agents, while acknowledging that infection represents the leading cause of mortality in transplant populations due to immunosuppression-related vulnerability.