Brain death and its impact on the donor heart - Lessons from animal models

In the light of increasing shortage of 'suitable' donor organs, donor management has become particularly important. Brain death has been recognized as being a determining factor in donor organ quality. Experimental brain death models demonstrate severe impairment of myocardial function and hemodynamic performance. An excessive catecholamine surge, occurring shortly after central catastrophe, seems to be associated with severe myocardial damage and subsequent cardiovascular changes. Acute neurohormonal failure resulting from extensive brain damage and concurrent metabolic dysbalance contributes to progressive functional deterioration. However, it still remains controversial as to which factors determine whether hearts undergo complete recovery or progress to extensive subendocardial necrosis after brain death and subsequent procurement. Future investigations of the underlying molecular mechanisms may provide further insight into the process accompanying this central catastrophe, and may lead to therapeutic strategies to improve donor organ quality.