Transplantation of organs from brain dead patients has evolved as the treatment of choice for many patients with end-stage organ disease, but the shortage of available donors limits      solid-organ transplantation. Improvements in donor management, surgical techniques, and           peri-operative care together with effective immunosuppressive treatments have contributed to an increasing success rate of transplantations during recent years. It has also encouraged the use of older, marginal, and higher risk donors without comprising the outcome of the recipients. In spite of this, the gap between supply and demand continues to widen, and it has become increasingly important to maximize the number of available donors.
Brain death is a term that has been used since inception of the criteria. Today, death by neurological criteria is now the term favored by intensive care doctors and neurologists. Donation after cardiac death was previously known as the Non-Heart Beating Donation. 
Potential donors fail to become actual donors due to mainly three reasons, family refuses consent for organ donation, donors are lost secondary to hemodynamic collapse and subsequent cardiac arrest, and the donors are deemed unsuitable according to acceptance criteria. Failure to provide adequate physiological support to potential donors accounts for 25% of lost donor organs. The majority of transplants use organs from heart beating donors after brain death. Brain death organ donors are more likely to donate multiple transplantable organs and are currently the only source for cardiac transplants.
Brain death induces considerable hemodynamic, hormonal, and metabolic changes, which, if not managed, can lead to deterioration in organ function before retrieval. In some cases, this prevents successful donation that if untreated may result in cardiac arrest. Early in the history of brain dead organ donor management, it was recognised in cardiac transplantation that the donors were frequently unstable. Hypotension and hypothermia were common, and resuscitation with intravenous fluids and vasopressor drugs was often required. Diabetes insipidus was not always actively managed, leading to hypernatraemia and dehydration. The other problems were arrhythmia-bradycardia, anemia, coagulopathy and hyperglycemia. There was a wide variation in the choice of treatments, particularly in relation to cardiovascular support.
There is increasing evidence that moderation of these pathophysiological changes by active management in Intensive Care maintains organ function, thereby increasing the number and functional quality of organs available for transplantation. Early and aggressive hemodynamic management and hormonal support may delay and temporarily reverse these events of hemodynamic and metabolic derangements. The management focus shifts from cerebral protection strategies to optimizing donor organs by maintaining organ perfusion and tissue oxygenation. The support is intensive and time consuming.
Most transplant centers have standardized donor organ management protocols focusing on hemodynamic and hormonal resuscitation. One of them is the ‘rule of 100’; systolic blood pressure >100mmHg, urine output>100ml/h, hemoglobin>100gm/l, and blood sugar 100% normal. The hormone replacement therapy includes vasopressin, methylprednisolone, insulin and triiodothyronine.
Donor management programmes with the best results stress the importance of high-quality intensive care management of the potential heart beating organ donor. They advocate the early use of advance monitoring to guide the management of complex cardiovascular changes and the involvement of an experienced intensivist in donor care. Although there is considerable agreement on the appropriate physiological goals, there is significant variation in the therapies and techniques used to achieve these. This is because the optimal combinations of treatment goals, monitoring, and treatment techniques have not yet been fully defined. A skilled retrieval team is also of utmost importance. The key to future developments and research into the component techniques is to ensure that currently recommended therapies are delivered   consistently and to a high standard.
References:

1. Mckeown DW, Bonser RS, Kellum JA. Management of heartbeating brain-dead organ donor. British Journal of Anaesthesia 2012; 108 (S1): i96-i107
2. Bugge JR. Brain death and its implications for management of the potential organ donor. Acta Anaesthesiologica Scandinavica 2009; 53: 1239-1250
3. Rech TH, Moraes RB, Crispim D, Czepielewski MA, Leitão CB. Management of the Brain-Dead Organ Donor: A Systematic Review and Meta-Analysis. Transplantation 2013. 95 (7); 966-974                                                                                                                                                 
4. Novitzky D, Cooper DKC, Wicomb W. Hormonal therapy to the brain-dead potential organ donor: the misnomer of the ‘Papworth Cocktail’. Transplantation 2008; 86: 1479