This chapter discusses the physiological changes of brain death, the management of complex patients, the organization of the recovery, and new technologies that may allow increased number of organs available for transplantation. Most lethal brain injuries follow a common pathway whereby a patient suffers brainstem death secondary to sudden or gradual increases in intracranial pressure (ICP). Hemodynamic instability seen after brain death is also consequent to loading conditions imposed on the heart. The physiological changes of brain death have direct and indirect effects on lung function. Traumatic brain injury accounts for one third of all trauma related deaths. Early assessment of renal and liver quality is performed in cases of donor death secondary to trauma, exclusion of liver injury. It has been shown that treatment of ex vivo human lungs with an adenoviral vector encoding for interleukin (IL)-10 decreased inflammatory cytokine expression and led to significant improvements in graft function.

There are four types of organ donation: living donation, xeno-transplantation, non-heart-beating donation (NHBD) and heart-beating donation (HBD). All patients who have confirmed brainstem death can be heart-beating donors. NHBD should be considered in any patient who is above 60 years of age, and has an irreversible condition so that after withdrawing treatment death is inevitable. The Advisory Committee on the Microbiological Safety of Blood and Tissues for Transplantation (MSBT) provides national guidance on donor evaluation and testing. The public is very supportive of organ donation in principle, with 15 million already on the NHS Organ Donor Register. However, the actual donation rate remains poor, partly due to 40% of relatives refusing to give consent. In 2006, the UK government set up the Organ Donation Taskforce (ODTF) to identify barriers to organ donation and draw up actions needed to increase organ donation.