Anesthetic Management of Brain-Dead Donors During Organ Retrieval: Hemodynamic Effects and Potential Organ-Protective Implications – A Retrospective Analysis of 85 Cases

Currently, no evidence-based recommendations for anesthetic management of brain-dead organ donors exist. Hemodynamic responses to surgical stimulation and potential organ-protective effects of anesthetic agents have been reported inconsistently. We retrospectively analyzed anesthetic management of all donors at University Hospital Münster between 2010 and 2025. Heart rate (HR) and mean arterial pressure (MAP) were assessed before, during, and up to 15 min after first incision. Eighty-five donors were included; volatile anesthetics were administered in 41%, opioids in 80%, and neuromuscular blocking agents in 92%. HR (bpm) remained unchanged from before (94 [85-105]) to during (93 [84-104]) and post-incision (95 [85-103]). MAP (mmHg) decreased from 5 minutes (86 [76-95]) to 15 min post-incision (80 [72-89]; p = 0.034). Sufentanil did not affect HR or MAP at any point. Sevoflurane was associated with lower HR at all time points (p < 0.001) and lower MAP during incision (p = 0.020), but independent of surgical stimulation. Anesthetic management varied substantially. Hemodynamics did not increase following incision, and our findings do not support opioid administration, whereas hemodynamic effects of sevoflurane must be carefully managed to ensure sufficient organ perfusion during retrieval. Evidence-based recommendations for anesthetic management are needed to support organ-protective strategies in organ donation.