The influence of brain death and intensive care management on donor organs: Assessment of inflammatory markers

© 2013 Springer Science+Business Media New York. All rights reserved. The observation that kidney transplants from living donors have superior short- and long-term outcome compared to kidneys donated after brain death prompted research into the events surrounding brain death. Experiments in animals have clearly demonstrated that brain death is associated with a systemic inflammatory response that affects the peripheral organs. A number of studies have demonstrated that brain death results in the release of cytokines and chemokines leading to activation of endothelium and leukocyte recruitment into various organs. These changes have important consequences, such as increasing the immunogenicity of the organ, amplifying reperfusion injury and increasing the incidence of acute rejection following transplantation. Importantly, other experiments and recent clinical evidence shows that strategies designed to reduce the inflammatory response result in improved graft outcome following transplantation. In an era of organ shortage, more organs from marginal donors are used for transplantation; minimizing additional injury related to brain death may potentially increase the number and quality of organs for transplantation.