Donor management and matching.

Medical management of the multiorgan donor is an essential component of the success of heart transplantation. Appropriate management demands an understanding of the progressively changing pathophysiology of brain death such that rapid diagnostic and therapeutic intervention may be accomplished. Specific problems such as hypovolemia, diabetes insipidus, neurogenic pulmonary edema, electrolyte imbalance, and loss of temperature regulation require aggressive treatment. Early potential donor recognition, expedient diagnosis of brain death, careful maintenance of satisfactory end-organ function, and appropriate donor-recipient matching are important aspects in the management of the multiorgan donor that will maximize successful application of transplantation to the highest number of qualified recipients.