STRATEGIES FOR MAINTAINING POTENTIAL DONORS IN BRAIN DEATH: A SYSTEMATIC REVIEW

Introduction: The maintenance of potential organ donors after the diagnosis of brain death represents a decisive phase in the transplantation process, as profound hemodynamic, endocrine, respiratory, and inflammatory disturbances may rapidly compromise organ viability if not adequately managed. Objective: The main objective of this systematic review was to synthesize contemporary evidence on clinical strategies for maintaining physiological stability and preserving organ viability in potential donors after brain death, with secondary objectives focused on hemodynamic optimization, endocrine replacement, ventilatory management, infection control, and the impact of protocol-based multidisciplinary care. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the ICTRP, including clinical studies that evaluated donor maintenance strategies after brain death. Studies published within the last five years were prioritized, with qualitative synthesis performed due to heterogeneity of interventions and outcomes. Results and Discussion: A total of 28 studies were included in the final review, encompassing observational cohorts, multicenter analyses, and interventional studies conducted in intensive care settings. The evidence consistently indicated that goal-directed hemodynamic management, hormonal therapy, lung-protective ventilation, structured infection control, and standardized multidisciplinary protocols were associated with improved physiological stability, increased organ yield, and enhanced suitability of organs for transplantation. Conclusion: Current evidence supports the implementation of active, protocol-based, and multidisciplinary donor maintenance strategies in intensive care units to optimize organ preservation and improve transplantation outcomes, while highlighting the need for further high-quality interventional research to refine and standardize best practices.