**1. Introduction**

Transplantation is the definitive treatment for solid organ end-stage disease. The waiting list for organ transplant is growing rapidly and the available offer of suitable organs is not sufficient enough to satisfy the needs. Within the Eurotransplant region and worldwide, the majority of transplanted organs are obtained from deceased brain-dead donors [1].

It is well known that the results from kidney grafts retrieved from living donors (both related and unrelated to recipients) are far superior to those of deceased organ donors in terms of delayed graft function, acute rejection and graft survival [2–4]. As there is a significant difference between short- and long-term survival of kidneys from living and deceased donors, the focus has recently shifted from recipient to donor and the events occurring at the time of and after brain death.

Brain death is a catastrophic event resulting in severe systemic disturbance including haemodynamic instability, inflammatory, hormonal, metabolic and hematological disorders [5]. A limiting factor for better transplant outcome in a

#### *Organ Donation and Transplantation*

potential organ donor is definitely activation of the immune system that starts early, during and immediately after brain death. For this reason, brain death has become one of the key factors believed to significantly impact transplant function and survival.

Early identification of potential donors is essential to establish timely and aggressive donor management so as to provide the quantity and quality of organs available for successful donation and transplantation. Unfortunately, no standardized guidelines for the management of brain-dead donors have been implemented to this moment [6]. Nevertheless, the main goal for successful organ donation is to normalize and maintain the physiological conditions, including haemodynamic stability, adequate oxygenation, and optimal fluid and electrolyte balance. Aggressive respiratory and haemodynamic monitoring is thus essential to prevent any unnecessary loss of organs [7].
