There are still many controversial aspects regarding which method is best for managing organ donors to prevent, lessen, or even reverse the organ alterations associated with
brain death. Fundamental aspects are the management of an adequate perfusion pressure,
hormone restoration, and opposition of the inflammatory state associated with
brain death. Once volume has been normalized, it is necessary to administer vasoactive drugs, including
catecholamines to re-establish the loss of sympathetic tone at the vascular and myocardial level. It is impossible to define the ideal or maximal
catecholamine dose because it depends on the donor's vascular tone, vascular reactivity, and pharmacokinetic variability characteristic of critical patients, particularly organ donors. To control early onset of
diabetes insipidus, it is necessary to administer
desmopressin. At present there are insufficient clinical studies to show the usefulness of
triiodothyronine. Furthermore, due to its limited availability, elevated cost, and probable side effects, the use of this
hormone is not justified. More importance is being given to the negative influence of the inflammatory state associated with
brain death, which has repercussions on organ viability and probably influences the prevalence of rejection episodes. Meanwhile in organ donor management, we recommend the use of 15 mg/kg of
methylprednisolone as soon as possible. Contrary to
triiodothyronine, the potential benefit of its immunomodulatory effects, its low cost, and the absence of major side effects justify this recommendation.